The Pennsylvania Health Law Project has published the March 2013 edition of Health Law PA News, its monthly newsletter.Features this month include articles about the governor’s proposed FY 2014, prospects for Medicaid expansion, coming Affordable Care Act changes, the final expansion of HealthChoices, and more.
Find a link to the complete newsletter here
, on the web site of the Pennsylvania Health Law Project.
Pennsylvania ranks 43rd of the 50 states in public health spending, according to a new report issued by the Robert Wood Johnson Foundation and the organization Trust for America’s Health.
While the median annual public health expenditure per capita nation-wide is $27, Pennsylvania spends only $14 per capita on public health.
Public health encompasses such functions as protecting the water and food supplies, inspecting restaurants, promoting good health, guarding against environmental hazards, and tracking the spread of infectious diseases.
Read more about the state’s role in public health and why Pennsylvania rates so poorly compared to other states in this Allentown Morning Call article
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Still rejecting expansion of the state’s Medicaid program as envisioned under the Affordable Care Act, Pennsylvania Tom Corbett has indicated that he may be interested in following the lead of a few other states in attempting to use federal Medicaid expansion money to purchase private health insurance for newly eligible Medicaid recipients.
This news comes in the aftermath of the governor’s Washington, D.C. visit with Health and Human Services Secretary Kathleen Sebelius during which the two officials discussed the governor’s reluctance to incur the future cost increases that he believes the state will face under Medicaid expansion.
Recently, the governors of Arkansas, Ohio, and several other states have expressed interest in purchasing private insurance for new Medicaid recipients instead of expanding their states’ traditional Medicaid programs.
Read more about Governor Corbett’s meeting with Secretary Sebelius and the possibility that the state’s closed door to the question of Medicaid expansion is now slightly ajar in this Philadelphia Inquirer article.
Participation in Pennsylvania’s Children’s Health Insurance Program (CHIP) has fallen by nearly 100,000 children since mid-2011.
Much of the decline is being attributed to a reduction in the state’s marketing of the program in recent years. Additional money for marketing is included in Governor Corbett’s proposed FY 2014 budget.
Read more about the extent of the fall in CHIP enrollment and why it has occurred in this Philadelphia Inquirer article
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Penalties imposed on hospitals deemed to have excessive readmissions of Medicare patients may disproportionately target safety-net hospitals, some health care experts maintain.
Such penalties are part of Medicare’s hospital readmissions reduction program.
According to the recent New York Times article “Hospitals Question Medicare Rules on Readmissions,” “…health policy experts and hospital executives say the penalties, which went into effect in October, unfairly target hospitals that treat the sickest patients or the patients facing the greatest socioeconomic challenges.” The article goes on to cite a recent report in the New England Journal of Medicine, noting that “Large academic medical centers and so-called safety-net hospitals are bearing the brunt of the new policy, and the authors warn that the penalties could make it even harder for hospitals struggling to care for those patients with the highest needs.”
Read the Times article here.
The common perception that many hospital emergency rooms are significantly overused by people not suffering genuine medical emergencies may not be accurate according to a new report published in the Journal of the American Medical Association.
According to the study “Comparison of Presenting Complaint vs. Discharge Diagnosis for Identifying ‘Nonemergency’ Emergency Department Visits,” many ER patients who turn out not to be suffering genuine medical emergencies present with virtually the same symptoms as patients who are suffering true emergencies. This suggests that it may be unreasonable in at least some cases for patients to determine whether their medical problems genuinely require emergency assistancePennsylvania’s safety-net hospitals typically experience very high emergency room utilization.
Overuse of hospital emergency rooms is frequently cited as a major cause of rising health care costs.
Read more about these latest findings in this New York Times blog entry and find the JAMA study here.
A new study suggests that expanding Medicaid eligibility in Pennsylvania would create as many as 39,000 new jobs over the next seven years and generate enough new revenue to pay the state’s share of the expansion’s costs.
Or so says a new study by RAND Health.
According to the study, Medicaid expansion under the terms established by the Affordable Care Act would reduce Pennsylvania’s uninsured rate from the current 12.7 percent to 4.8 percent in 2016, spur $20 billion in economic growth by 2020, and generate more new tax revenue than the state would need to spend to pay its share of expansion’s cost once the federal share of expansion drops from 100 percent to 90 percent.
The Safety-Net Association of Pennsylvania (SNAP) supports Medicaid expansion in the state.
Read more about the RAND Health report, and find a link to the study, in this Central Penn Business Journal article.
In their desire to persuade states to expand their Medicaid programs as called for in the Affordable Care Act, federal officials are now suggesting that states could use new federal Medicaid funds to enable Medicaid-eligible people to purchase private insurance.
Even though this was not envisioned in the health reform law, the prospect of making greater use of the private sector appears to be appealing to many Republican governors who have otherwise been reluctant to commit their states to expanding their Medicaid programs.
Pennsylvania has no current plans to expand Medicaid eligibility, although there appears to be growing interest in doing so throughout the state. Expansion would add approximately 500,000 people to the state’s Medicaid rolls, many of whom would be served by safety-net hospitals. The Safety-Net Association of Pennsylvania (SNAP) supports Medicaid expansion in the commonwealth.
Read more about how this idea came about, why many states find it appealing, how it would work, and what the potential challenges are in this New York Times article.
Immigrants to the U.S. – legal and not – pose a special challenge in the health care environment of the future.
Legal immigrants will not be able to benefit from many of the Affordable Care Act’s provisions until they have resided in the U.S. for five years while undocumented residents will not benefit from the reform law’s Medicaid expansion at all. Meanwhile, many of these individuals will continue to turn to health care providers, and especially to hospitals, when they are sick or injured.
But is this is a problem? And if it is, how great a problem is it? How many such individuals are there?
The Robert Wood Johnson Foundation has attempted to answer that question in a new report titled “State Estimates of the Low-Income Uninsured Not Eligible for the ACA Medicaid Expansion.” Among the report’s findings, it notes that
Safety-net health care providers are likely to continue to be key providers for this population after health reform, and the need for safety-net care will not be spread evenly across states. The capacity of safety-net providers to fill this gap will need to be assessed. While all states will need to develop strategies for meeting the health care needs of these adults, the challenges will be particularly difficult for safety-net providers in states with large numbers of immigrants who will not be eligible for Medicaid.
According to the report, about two percent of Pennsylvania’s non-elderly adults are unauthorized or recent legal immigrants; three percent of the state’s low-income, non-elderly adults are unauthorized or recent legal immigrants; and six percent of the state’s low-income, uninsured, non-elderly adults are unauthorized or recent legal immigrants.
Many of these individuals will undoubtedly turn to Pennsylvania’s safety-net hospitals for medical services.
Find the report here
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The Medicaid and CHIP Payment and Access Commission (MACPAC) has issued its March 2013 report to Congress.
The agency, created to advise Congress on Medicaid and Children’s Health Insurance Program (CHIP) issues, offered two recommendations in its report.
First, it recommended that Congress authorize states to implement 12-month eligibility for adults enrolled in Medicaid and children enrolled in CHIP, in much the same manner as they now do for children enrolled in Medicaid.
And second, MACPAC urged Congress to fund permanently Transitional Medical Assistance (TMA), which enables families that become ineligible for Medicaid because they now earn more money than the program’s limit to retain their Medicaid eligibility for several additional months.
The MACPAC report also includes analyses of several issues involving services for dually eligible (Medicare and Medicaid) individuals.
Because Pennsylvania’s safety-net hospitals serve so many Medicaid, CHIP, and dually eligible patients, MACPAC’s recommendations and analyses can be especially important to them.
Find the MACPAC March 2013 report here
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