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Lawmakers are reviving a bipartisan effort to keep coverage for Medicaid enrollees more consistent, amid uncertainty over the future of the program.
S. 1227, introduced by Sen. Sherrod Brown (D-Ohio) and referred to the Senate Finance Committee May 24, would offer continuous eligibility to the safety-net insurance program for a full year. It would do the same for the Children’s Health Insurance Program, which covers around 8 million children whose families fall between Medicaid eligibility and the ability to afford private health insurance. A House version, called the Stabilize Medicaid and CHIP Coverage Act of 2017, is being sponsored by Reps. Gene Green (D-Texas) and Joe Barton (R-Texas).
The idea is to clamp down on churn, which refers to beneficiaries going on and off the Medicaid rolls because of issues such as slight income changes or paperwork problems. With constant turnover, care becomes less consistent, and red tape and resulting costs go up, experts have found. Coupled with the possibility of drastic cuts to the program in the Trump administration’s fiscal 2018 budget proposal and the House-passed American Health Care Act, program stability has become a heightened focus.
The Association for Community Affiliated Plans, whose members include 60 safety-net health plans, praised the bill and encouraged more lawmakers and plans to sign on in support. ACAP has been a staunch proponent of uninterrupted coverage.
“This is a common-sense, bipartisan solution which strengthens the Medicaid and CHIP programs to assure beneficiaries coverage they can count on through 12 months of continuous enrollment,” ACAP CEO Margaret A. Murray said in a statement.
She added that the bill would allow better measurement of quality within Medicaid, since studies could be conducted over the course of a full year.
Currently, beneficiaries stay on Medicaid for an average of 9.7 months at a time, a problem often lamented among advocates of the safety net.
Noting the role churn plays in holding back patients, insurance plans, providers and government entities, the nonpartisan congressional advisory group on Medicaid has backed the idea of adding an option for states to extend coverage for 12 months at a time.
Modest changes—like picking up extra wages for holiday season shifts—can often hold families back from having any coverage at all, Sara Rosenbaum, health policy professor with the George Washington University, told Bloomberg BNA. She said implementing a full year of coverage would foster stronger relationships between Medicaid beneficiaries and primary care doctors.
Steadier coverage would ensure that the system would function smoother for both beneficiaries and Medicaid administrators, she added.
And there is evidence to bear that out: One Commonwealth Fund study found the yearlong eligibility window would reduce churn in Medicaid by 30 percent, albeit with potential cost increases for maintaining the insurance.
“This brings [Medicaid beneficiaries] on par with enrollees in private health plans and Medicare,” Murray said.
Medicaid Health Plans of America, which also represents managed-care plans, declined to comment on the proposal. The National Association of Medicaid Directors also did not comment.
Rosenbaum told Bloomberg BNA the bill’s underlying message is that lawmakers see Medicaid as a critical health insurance program and one that should be imbued with the same qualities as private insurance.
A larger debate has been unfolding over the nature of the program, which now covers more than 73 million people.
Some see the safety-net program as a temporary stopgap that has become fiscally unsustainable and needs to be overhauled to rein in spending and refocus on those truly in need. Republican health-care proposals have suggested doing so by putting Medicaid on a budget, winding down the Affordable Care Act’s expansion, and implementing work requirements.
GOP lawmakers point to data showing that the program is expected to grow and cost the federal government $624 billion by 2026. They also have highlighted its status as a high-risk program for waste, fraud and abuse.
Those in favor of the status quo under Obamacare praise Medicaid’s new role as the nation’s largest health insurer and how it has become woven into the fabric of public health, playing large roles in everything from opioid abuse treatment amid a massive crisis to disability care and maternity health and contributing to drops in uninsured rates across the board.
S. 1227 “is sort of swimming against the current [of retracting Medicaid expansion], but I think it’s extremely important to keep talking about the things that really matter,” Rosenbaum said.
John Feore, a director with consulting firm Avalere Health, said continuous eligibility was not an inherently political proposal but instead a policy effort to address a real issue within Medicaid.
Barton, the lone Republican sponsor of the House bill, has supported the Obamacare replacement bill, the American Health Care Act (H.R. 1628). That bill would dramatically reduce the number of Medicaid beneficiaries. He called the bill’s House passage a “substantial step forward.”
“Obamacare has failed to provide better coverage at lower costs through government mandates,” Barton said in a statement. “Americans are capable and, when given the necessary facts and options, they will find the best fit for themselves and their families.”
Barton’s name on the Stabilize Medicaid and CHIP Coverage Act might help to garner more Republican support, Feore told Bloomberg BNA.
But even with this—and with what would likely be health-care organizations’ support because of the problem with churn in both Medicaid and CHIP—the bill’s chances are uncertain. Feore said the bill is landing at a time when anything health-care-related is controversial.
“The political dynamic of Medicaid funding and the ACA repeal-and-replace debate might make it difficult to move forward with some more ... policy-focused ideas,” he said.
If it does advance, Feore added, it would likely be in a vehicle like CHIP reauthorization, which needs to happen this year or the program would run out of money.
Rosenbaum agreed the bill’s viability is in question.
“This is certainly a challenging time period for anything progressive, for a bill like this that would improve the strength and performance of the program,” she said.
Still, she said Medicaid Section 1115 demonstration waivers might be an avenue for the idea, given the Trump administration’s support of flexibility for states. New York, for example, already has implemented annual enrollment periods.
The House bill was first introduced in 2013, with 28 Democrats and just one Republican (Barton) signed on, according to Bloomberg Government. It died in the last Congress, legislative records from GovTrack show.
Feore said implementing a yearlong enrollment eligibility, if it goes through this time around, could mitigate worries over other current proposals.
“If this became law it would definitely help to assuage concerns of beneficiaries who may fear they’re going to lose Medicaid coverage,” he said.
Maybe they’ll take a small pay raise or different job without wondering if they might lose the health coverage they need.
It wouldn’t appease everyone though, he added.
“Obviously in the broader Medicaid and CHIP funding debate, those in favor of Medicaid expansion and reauthorizing CHIP... they’re not going to be happy if funding is significantly reduced and then you give them this.”
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