Medicaid

State Health Policy Resources for the COVID-19 Era

By M2|2020-03-26T17:05:27+00:00March 26th, 2020|Health Care Trends, Medicaid, Medicare, State Health Initiatives, Uncategorized|

State Health Policy Resources for the COVID-19 Era

M2’s focus has always been state health policy, and right now, WOW, there’s a lot of action at the state level! We pulled together a list of resources for anyone wanting to take a closer look at state actions and/or policies by state. See our list below and feel free to share additional state level policy resources you are finding useful.

Council of State Governments (CSG) is tracking state resources and restrictions and executive orders by state
Kaiser Family Foundation (KFF) is tracking state policy actions to address coronavirus with information in map, chart, and table form
The Center for Connected Health Policy is tracking state telehealth coverage policies in the time of COVID-19
Go to these CMS links for info on two popular Medicaid waivers right now:
1. Section 1115 waivers by state
2. Section 1135 waivers by state
The National Conference of State Legislatures (NCSL) is also posting state health policy COVID-19 related resources, including a map showing the open/adjourned/suspended status of state legislatures
The National Governors’ Association (NGA) is sharing their state action tracking chart via spreadsheet and PDF

What the Midterms Mean for State Health Policy

By M2|2018-11-09T20:29:48+00:00November 8th, 2018|Health care spending, Health Plans, Health Reform, Insurance, Medicaid, Out-of-pocket spending, State Health Initiatives, Uncategorized|

What the Midterms Mean for State Health Policy

The midterm elections have happened and all signs point to health care as a top issue in state legislatures in 2019. We have been telling our readers (and clients) this for several months, and Drew Altman, President and CEO of the Henry J. Kaiser Family Foundation, wrote in a guest post for Axios today: “most of the real action affecting people will be in the states.”

Approximately 4 in 10 voters told exit pollsters health care was the top issue for their voting choices. This isn’t surprising as health care costs are going up by about 5% a year, and consumers are being asked to pay a higher share of those costs, which is clearly putting pressure on state policymakers to do something.

States are under particular pressure because they are responsible for overseeing the individual and small group health insurance markets and Medicaid. Why does this matter? Because an increasing proportion of people are working, but don’t have access to employer-sponsored insurance, and can’t afford health insurance being offered in their state.

That is, people have jobs, but the jobs don’t offer health insurance.

In The Rise and Nature of Alternative Work Arrangements in the United States, 1995-2015, researchers at the National Bureau of Economic Research (NBER), Lawrence Katz from Harvard University and Alan Krueger of Princeton University, estimate:

…all of the net employment growth in the U.S. economy from 2005 to 2015 appears to have occurred in alternative work arrangements.

The researchers found between 2005 and 2015 workers in alternative work arrangements, such as “temporary help agency workers, on-call workers, contract workers, and independent contractors or freelancers – rose from 10.1 percent in February 2005 to 15.8 percent in late 2015.”

For these “gig workers,” buying health insurance coverage, for example in the Obamacare exchanges, means high premiums (see ) and very high deductibles, as the chart below from Avalere shows.

Deductibles of $4,000, $5,000, $6,000 are rarely seen in large employer insurance offerings. Only 20% of covered workers in large firms in 2018 had an annual deductible of $2,000 or more. Compare that to 42% of workers with a deductible of $2,000 or more in small firms (fewer than 199 workers), as the Kaiser Family Foundation chart below shows.

For the parts of the health care market states oversee, including the individual and small group insurance markets, state employees, and Medicaid, states will have their hands full in 2019 as they try to manage health costs for constituents who are working but can’t afford the health insurance options available to them.

It’s hard to understand why it’s reasonable that a freelancer or person working in a small firm can’t have access to the same affordable, robust health coverage as their counterparts in large firms.

Who Should Be Allowed to Help Patients Pay Health Costs?

By M2|2018-06-06T17:07:51+00:00June 6th, 2018|Health care spending, Health Care Trends, Health Reform, Insurance, Medicaid, Medicare, Out-of-pocket spending, Reimbursement, State Health Initiatives, Uncategorized|

Who Should Be Allowed to Help Patients Pay Health Costs?

If you can’t pay your health insurance premium, should you be allowed to have someone else pay it for you? What about your deductible? Your co-insurance or a copayment? These might seem like trick questions, but no. There really are circumstances when a person can’t receive help for health care costs. In the past few years, this has become a hot topic in health policy circles as health care costs continue to rise. At issue is a fundamental question we have considered before: whose health care costs should be managed, those of the healthy or the sick? Is it better to have sick people pay more so that healthy people who buy insurance can keep their premiums low? Or is it better to spread catastrophic health costs across larger pools of people so everyone pays a little in order to avoid ever paying a lot?

Third-party payments: Friend or foe?

When the Affordable Care Act was being debated nearly a decade ago, the American Enterprise Institute correctly pointed out, the entire U.S. health care system “relies on a third-party payment system.” That is, either individuals or employers make payments to insurers who in turn make payments to health care providers, or taxpayer money is used to pay health care providers who care for people covered by Medicaid, Medicare, TriCare or other public programs.

While the big picture debate of how to finance and provide health care services and for whom continues, this blog is focused on a more specific type of third-party payments (TPP). Right now, states and the feds are being asked to weigh in on which third parties should be allowed to pay insurance premiums or healthplan-required cost sharing, for example, a deductible or a health care service or product copayment. The debate at this moment is focused on people with chronic, severe, or expensive health care needs – people who need kidney dialysis, for example. The feds have been trying to work out guardrails since 2013 related to whether a third-party organization can pay for a person’s premiums in the state insurance exchanges. (For a deeper dive, go here). California has also joined the fray and is considering a bill, SB 1156, “Health care service plans: 3rd-party payments,” setting forth who will be allowed to make TPP for health insurance premiums.

Representing the “foe” side is America’s Health Insurance Plans (AHIP). A recent brief titled “How Third-Party Premium Payments Can Harm Consumers and Destabilize Markets” argues that TPPs from “entities steering Medicare and Medicaid eligible beneficiaries into qualified health plans (QHPs) sold through the Affordable Care Act (ACA) marketplaces…can increase the number of older and less healthy individuals in the individual market risk pool, resulting in higher premiums for all consumers and further destabilizing the market.” In support of SB 1156, the California Labor Federation presents a similar point-of-view, arguing that allowing TPPs of premiums for individuals with chronic or severe illnesses “also shifts costs onto commercial plans, driving up health care spending and increasing premiums for Californians already struggling with rising costs.” Who should pay when a person is sick? Is it always the better choice to shift costs to taxpayers by requiring a person who needs dialysis to enroll in Medicaid or Medicare, as AHIP suggests? How should we balance the interests of individuals and employers who want low health care premiums with the needs of patients with high health care costs?

Representing the “friend” side is The Commonwealth Fund in “Assessing the Promise and Risks of Income-Based Third-Party Payment Programs.” Their brief acknowledges the policy debate outlined above regarding TPP programs serving patients with specific health diagnoses, but focuses on TPP programs that address health care costs for a different population, noting, “History suggests that TPP programs can address low-income consumers’ affordability concerns on a large scale.”

Many of the guardrails set forth by The Commonwealth Fund parallel the California bill, including basing eligibility for TPP on income and paying “consumers’ premium shares from the point of enrollment through the end of the coverage year, thus preventing short-term enrollment that ends once a course of treatment is complete.” These guardrails seem to address several of the foe’s concerns. First, basing TPP on income means both the healthy and the sick can gain access to health insurance, which makes it much less likely that premiums rise due to a sicker risk pool. Second, AHIP argues consumers can be harmed “particularly if the third party stops making premium and cost-sharing payments once initial treatment is received, which could result in serious or life-threatening interruptions in access to care.” Requiring entities that provide TPPs to pay for more than just initial treatment addresses the foe’s concern.

I’m an aunt. Can I pay for my nephew’s prescription drug cost sharing?

One of the remaining concerns at the heart of TPP for health insurance premiums or health plan required cost-sharing (such as co-payments) relates to whether the organization making the TPP is motivated by financial gain or is steering patients to specific health care products, services, or providers. Federal law prohibits most TPPs in federal health programs, for example, Medicaid and Medicare, considering the TPPs to be in violation of one or another fraud and abuse law, such as the Anti-Kickback Statute and the Physician Self-Referral Law (Stark law).

While it makes sense that a health care provider should not be allowed to accept bribes, it is much less clear who should be allowed to help patients pay health costs. The way the U.S. health care system works today, if a person is not eligible for government-sponsored health care (for example, through Veterans Affairs, Medicare, or Medicaid) and they cannot pay for individual health care costs, whether premiums or cost-sharing such as copayments or deductibles, the person can usually be denied care. To be clear, AHIP is arguing that private entities, or groups of people, cannot come together and help such an individual make the health plan-required payments. The California bill says, “Any member of the individual’s family” can make a TPP, but then goes on to define “family” only to “include the individual’s spouse, domestic partner, child, parent, grandparent and siblings.”

This begs the question of what should be allowed when it comes to TPPs. What entities should be allowed to pay for patient’s health care costs?

Medical crowdfunding, such GoFundMe campaigns?
Health care sharing ministries?
Contributions gathered voluntarily by employees to help a co-worker with cost-sharing requirements? Or by a congregation to help a fellow churchgoer?
Employer emergency funds?
Family members helping family members, (let’s say Aunts, for example…)

It is quite clear that the alternative to the TPP being made is no payment being made, which certainly would cause an interruption in access to care for the patient who needs it. Like most health policy issues, TPPs can be either friend or foe and a one size fits all policy won’t work. Creating guardrails focused on allowing entities, including those in the list above, help patients pay their medical bills should be paramount.

States May Be Interested in Value-Based Payments, but Commercial Insurers Are Not

By M2|2018-05-31T15:01:26+00:00May 30th, 2018|Health Care Trends, Health Reform, Medicaid, State Health Initiatives, Uncategorized|

States May Be Interested in Value-Based Payments, but Commercial Insurers Are Not

CMS has issued the fourth of five planned annual reports on its Medicaid State Innovation Models (SIM) Initiative. Under the SIM initiative, six “test states” – Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont – have been awarded funds and are using policy levers to facilitate the creation or spread of innovative models and integrating population health and broader stakeholder perspectives into health care delivery and payment redesign models. The latest report describes the experiences of providers, health systems, consumers, payers, and state officials during the final full implementation year.

The evaluation, conducted by RTI International, working with The Urban Institute, National Academy for State Health Policy, and The Henne Group, found all six states have introduced value-based payment models (VBP models) in their Medicaid programs and are offering technical assistance to providers, social service and community-based organizations, and others to implement new delivery system models. States are also offering services, such as health IT and data analytic investment, that “enable or improve model effectiveness,” according to the Year 4 Annual Report.

However, the evaluation found “limited interest” among private payers and insurers in aligning their existing VBP models with state models. “All states struggled with effective engagement of private payers and insurers to expand VBP models beyond existing efforts and to achieve alignment across multiple payers,” the report finds. “Although private payers and insurers were willing to discuss the states’ conceptualization of VBP models, most did not make changes to the VBP models they offered to providers.”

As a result of limited interest among commercial payers, “states ultimately focused on Medicaid or state employee health plans over which they had control.”

There are several factors contributing to this lack of multi-payer alignment around common payment models, including a difference in business goals between Medicaid and commercial payers. Commercial payers in Maine, for example, reported issues related to value-based insurance design and multi-payer measure alignment; this was due to “insufficient engagement with payers” when the SIM goals were established, the report says. In addition, commercial payers in Maine are reluctant to change the design of their insurance products “in response to a single state’s recommendations,” and there is a “preference for making product design changes in response to their clients’ needs.”

If you are a business, your client’s needs come first. If a state becomes a client of an insurer, perhaps this VBP model alignment problem would be easier to solve. But other state’s experiences would indicate that is unlikely.

The RTI evaluation identified several other factors contributing to the lack of payer alignment in payment models including: the proprietary nature of information (e.g., commercial payers in Minnesota preferred not to share details on quality and utilization measures and performance reports for providers, which “limited the type of dialogue necessary to advance multi-payer payment reform”) and competitive concerns (e.g., payers that have invested in changes in payment reforms are “concerned that the returns on those investments are accruing to other parties”).

Many of these concerns are age-old problems; in the policy world, we encounter these types of issues frequently: (1) the complaint that “you didn’t engage us from the beginning;” (2) the fact that health care delivery is competitive in a capitalist market; and (3) the free rider problem.

We could add two more issues or concerns to the list above: (4) “You don’t understand clinical issues” (e.g., physicians in Arkansas felt that “state decision-makers were too far removed from daily clinical practice to understand what would work effectively”) and (5) We would have to create multiple products – e.g., products tailored to the needs of the Medicaid population vs. commercial population.

In the six test states, participation by health care practitioners in innovative models varies wildly. For example, in testing an integrated care model, the number of participating providers varied such that in Massachusetts, 10% of the Medicaid population was reached, while in Oregon, the comparable figure was 85%, as noted in the chart below (from the evaluation report):

For tests of the patient-centered medical home (PCMH) or health home model in these six states, 17% of the Medicaid population was reached in Maine, compared with 70% in Vermont and 75% in Oregon.

Engaging private payers in innovative payment models is important for health care system transformation. Given that some payers in these six test states were reluctant to change the design of their insurance products in response to a single state’s recommendations, states might consider combining forces for the purposes of designing more responsive VBP models. Another alternative is to ask insurers, along with representatives from other health care entities, consumer groups and employers to participate in system design change from the beginning of the process. VBP may lead to health cost reductions if implemented widely and well, but such achievements will be nearly impossible if entities that control so much of a population’s health care coverage choices are not involved.

It’s a Hospital, It’s a Health Plan, It’s Both!

By M2|2018-04-20T18:55:42+00:00April 20th, 2018|Health care spending, Health Plans, Hospitals, Insurance, Medicaid, Medicare, Uncategorized|

It’s a Hospital, It’s a Health Plan, It’s Both!

Tufts Health Plan (Watertown, MA) and hospital company Hartford HealthCare (Hartford, CT) have announced a joint venture to form an insurance company, which will focus on providing those over 65 who qualify for Medicare the alternative of purchasing a Medicare Advantage plan.

The “twist” with this joint venture is that it will bring together an insurer and a hospital firm in one company and “it’s a first for Connecticut.”

Like many of the new health care collaborations sprouting up, such as Aetna-CVS and Berkshire Hathaway, Amazon and JPMorgan, the name of the game right now is using data better to try to lower costs.

Hartford is looking to Tufts Health Plan to bring “insights around closing gaps in care, identifying members who have needs they may not even be aware of and better coordination of care,” James Cardon, Hartford’s chief integration officer, told the Hartford Courant. Tufts has 1.1 million members across New Hampshire, Massachusetts, and Rhode Island.

Collaborations between health plans and providers are not unknown; however, they are in “relative infancy, and many of the approaches don’t involve as extensive as a commitment that is implied and inherent in a joint venture,” according to Tufts CEO Thomas Croswell.

A key advantage of the joint venture is that it will combine clinical data from Hartford with claims data from Tufts Health Plan, giving the partners the ability to reach out to members. Inherent in these concepts is reaching patients before they have serious health care needs.

Hartford HealthCare CEO Elliot Joseph explained the joint venture was built specifically to address both organizations’ realization that there’s room for improvement in care for patients with chronic conditions, especially in helping seniors manage their care in order to avoid hospitalizations. If reducing costs is the goal, it makes sense that Tufts and Hartford HealthCare are focusing initially on seniors, given their high use of health care services; however, such a strategy is unlikely to work for other populations.

In another example of provider-insurer consolidation, Centene Corp., a Medicaid managed care insurer and the “dominant health plan on the Affordable Care Act exchanges,” plans to buy Florida-based primary-care provider Community Medical Group.

Community Medical will boost Centene’s scale and capabilities around care delivery, and Centene will gain access to the provider’s patient population.

Community Medical Group operates 13 medical centers and two specialty centers serving more than 70,000 Medicaid, Medicare Advantage, and Affordable Care Act exchange patients in Miami-Dade County, FL. As of the end of last year, Centene had 848,000 Florida plan members, and that number is expected to increase as it grows membership in the ACA exchange in Florida.

Centene also announced recently that it has agreed to buy MHM Services, a provider of health care and staffing services to correctional facilities and government agencies, serving 330,000 people.

This strategic approach is all about controlling where plan members receive care, similar to previous deals where an insurer buys a provider group. UnitedHealth Group’s Optum subsidiary bought DaVita’s medical group and acquired Surgical Care Affiliates last year. Humana also bought home healthcare provider Kindred Healthcare last year.

The health care system in the U.S. is changing rapidly. With less direction (or interference, depending on your point of view) from the federal government, health plans and provider groups are leading the way in creating new approaches for care delivery. Whether payers, including employers and consumers are better off, is yet to be seen.

Nearly Every State Engaged in Value-Based Payment Models

By M2|2018-03-14T17:37:20+00:00March 14th, 2018|Health Care Trends, Health Reform, Innovation, Medicaid, State Health Initiatives, Uncategorized|

Nearly Every State Engaged in Value-Based Payment Models

Value-based payment is not just for Medicare and private payers, states are also engaged in a multitude of value-based payment initiatives. While variation exists in the scope, leadership commitment, and resources devoted to these efforts, “more than 40 states have a state-initiated plan or strategy” to move toward value-based payment instead of fee-for-service (FFS) payment, and “almost half of those initiatives are multi-payer in scope,” according to the report by Change Healthcare, based on a national study of publicly available information compiled from May through October 2017.

Of note:

Of the states engaged in VBP, nearly all are using patient-centered medical homes (PCMH) or health homes (HH).
For the most part, these tests are being tried in Medicaid; 31 states are testing one of these value-based approaches in Medicaid alone. In three states, they are testing at least one of the two in Medicaid and with their state employees: Oklahoma, Tennessee, and Washington. Thirteen states have multi-payer efforts: Arkansas, Colorado, Connecticut, Delaware, Idaho, Iowa, Maryland, Michigan, New York, Ohio, Pennsylvania, Rhode Island, and Vermont.
Fourteen states have chosen the ACO model: seven in Medicaid (Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New Jersey, Oregon), two in Medicaid and with state employees (Oklahoma, Washington), and five in multi-payer arrangements (Colorado, Iowa, New York, Rhode Island, Vermont).
Episodes of care (EOC) is another approach being used; currently in 12 states though some are considering it and some only use EOC in a single service area: Colorado, Maine, and South Carolina are considering EOC; New York is using it only in maternity and chronic care; Washington is using it only for total joint episodes of care.
Pay for performance is also being tried in the following 12 states: California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Iowa, Maryland, Missouri, New Hampshire, Texas, and Wisconsin.
Seven states have “little to no activity around value-based payment” (Georgia, Indiana, Louisiana, Mississippi, North Dakota, South Dakota, Wyoming).

The following map (created by M2 based on data in the Change Healthcare report) shows the details of each state’s initiatives in this area:

For a few states, testing alternative payment models is not new. Some states have been engaged in these efforts for nearly a decade. Minnesota was the first state to engage in a value-based payment approach of some sort, in 2008. Colorado and Maryland began their efforts in 2011; Oregon in 2012, Arkansas and Vermont in 2013.

States are often the leaders in testing new ideas. Alternative payment models for health care are no different. As health care costs continue to rise, and most states need to balance their budgets every year, it makes sense that finding different ways to pay for Medicaid and state employees’ health care is something nearly every state is focused on.

VBP is not dead, as evidenced by nearly all states are taking action to transition from a FFS approach to one that is focused on value. To slow health care costs, we have to stop paying for what doesn’t work. The more we can reward outcomes in health care, the more likely it is that providers and patients will make decisions based improvements in care, rather than adverse financial incentives for low-value care.

Health Care Expenditures and You. Know Your Numbers.

By M2|2018-02-16T16:58:12+00:00February 15th, 2018|Health care spending, Health Care Trends, Medicaid, Uncategorized|

Health Care Expenditures and You.

Know Your Numbers.

As a Valentine’s Day gift to health policy types, the economists in the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) published the National Health Expenditure Projections for 2017–26 and Health Affairs published an insightful analysis, as well. The storyline has been pretty consistent for the past few years and looking forward to 2026, several trends are intact:

The U.S. population is aging, which is pushing health cost trends higher.
Medicare spending is growing faster than private spending as Baby Boomers age out of private insurance plans through their employers and into Medicare.
A “higher share of aged and disabled enrollees” continues to contribute to faster growth in Medicaid spending.

The topline is that health spending growth, provided there are no significant policy changes, is expected to increase around 5 to 6 percent per year from 2017-2026. If this is estimate is correct, by 2026 health care will account for nearly 20 percent of the U.S. economy, compared to 17.9 percent in 2016. Digging deeper into the estimates reveals some items that may not have crossed your radar yet:

The rate of 5.5 percent per year from 2017-2016 is much less than the 7.3 percent average increase per year the U.S. experienced from 1990-2007.
Prices for medical goods and services saw historically low growth rates of just 1.1 percent per year between 2014 and 2016, and will average 2.5 percent per year in 2017–26.
The projected price increases for medical goods and services at 2.5 percent is much lower than the 3.3 percent average annual growth rate in 1990–2007.

These low price increases might seem surprising if you rely on general news reports, but it is really just a matter of thinking about which numbers are being reported, by whom, and about which group of people. For example, earlier this month, Express Scripts, a pharmaceutical benefits manager with more than 34 million members, published their annual Drug Trend Cost Report announcing a Record-Low Increase in Rx Spending in 2017. “Commercial plans saw the lowest increase in drug spending in 24 years – just 1.5%, compared with 3.8% in 2016,” explained the report. In Medicare, “total per-person spending increased 2.3%, with diabetes leading all classes.” In Medicaid, “total per-person spending increased 3.7%, with HIV leading all classes.” For the health insurance exchanges, “total per-person spending decreased 3.3%.” These numbers are just about drug spending.

If you look at yet another set of data, you get yet another picture. The Health Care Cost Institute (HCCI) 2016 Health Care Cost and Utilization Report explained, “Total spending per person is now growing at faster rates than prior years, with 4.6% growth in 2016.” The HCCI report is based on claims in employer-sponsored insurance sponsored by Aetna, Humana, Kaiser Permanente, and United Healthcare for 39 million members. The report produces a “per-person health care spending estimate” that only includes the amount the insurance companies paid and the cost-sharing amount the patients paid for those services. It does not include the premiums that consumers or employers paid, however.

The HCCI report agrees with the Express Scripts report, however, by noting, “In 2016, increased spending on outpatient services was the biggest contributor to the annual growth in total spending. This is a change from prior years. In 2014 and 2015, prescription drug spending was the biggest contributor to total spending growth.”

You can see that different reports, written for different audiences and looking at different cuts of the data, reflect different truths – and all are based in fact.

One Thing is For Sure, Patients Aren’t the Problem

The State Of Health Care Today: How Physicians, Consumers, and Employers View Health Care Costs, Outcomes, and Reform Efforts, a survey of more than 600 physicians, 500 employers, and 5,000 consumers published in January 2018 by Leavitt Partners, explains these dueling data sets fairly well, though my guess is that was not their intention. The report explains, “In general, physicians, employers, and consumers agree that the health care system requires change; however, they disagree on what changes are needed, who is responsible for making changes, and which reform efforts hold the most promise.” This makes sense because most people’s experience and understanding of health care is personal. It’s about my health care provider, my insurance coverage, my health care costs.

As this chart from the Leavitt report shows, when asked who or what is responsible for the problems with the U.S. health care system, patients mostly blame the government, physicians primarily blame insurance companies, and employers blame both government and insurance companies nearly equally. Patients seem to have escaped blame, however, at least for the more than 7,000 people in the Leavitt survey. Keep that in mind the next time you see a news report about health care expenditures and a recommended policy change. Know your numbers. It might change your policy life!

The Future of Medicaid – Implications for Patients and Action for Advocates

By M2|2017-10-08T11:36:02+00:00July 13th, 2017|Health Reform, Medicaid, Uncategorized|

The Future of Medicaid – Implications for Patients and Action for Advocates

I had the privilege of talking with nearly 100 patient advocates recently about the Medicaid proposals under consideration in the House and Senate bills aiming to “repeal and replace” Obamacare. As part of a webinar series hosted by the Patient Advocacy Leaders Summit (PALS), a national initiative convened by The AIDS Institute, I presented ideas for ways patient advocates could continue to work on behalf of themselves and their members to communicate with elected officials and policymakers about the importance of Medicaid to their access to health care.

PALS introduced the webinar as follows:

“As Congress and the Administration continue to move toward efforts to repeal and replace The Affordable Care Act, Medicaid has emerged as one of THE major points of contention, with its future being widely debated. Revamping Medicaid would affect access to health care and services for millions, who represent some of the most vulnerable populations.

Both the House bill, The American Health Care Act (passed May 4), and the Senate Republican’s proposal, The Better Care Reconciliation Act of 2017 (released June 22), aim to reduce federal health care spending and cap Medicaid while shifting greater responsibility to the states. Both plans will cause millions of Americans to go without coverage and struggle with health care bills.

Our speakers will share their perspectives and insights regarding the future of Medicaid, implications for patients and what you as an advocate can do to make a difference as Medicaid, and our entire health care system, is being transformed.”

Alongside co-presenters, Candace DeMatteis, the Policy Director of Partnership to Fight Chronic Disease (PFCD) and Matt Salo, the Executive Director of the National Association of Medicaid Directors (NAMD), we underscored three central themes:

Real people, with serious health care needs, will lose access to care;
People who rely on Medicaid are people you know or encounter in your daily life; and
Familiarity with Medicaid, through real-life stories, helps everyone understand how the program provides health care to those who need it most.

Real people will lose access to health care

Of the people who will be directly affected by the proposed reforms, many have serious health care needs. As we have explained in previous blogs, health care costs in the U.S. are highly concentrated. In 2012, the top 1% of spenders accounted for 22.7% of all U.S. health care expenditures, the top 5% of spenders accounted for 50% of expenditures, and the bottom 50% of spenders accounted for less than 3% of expenditures.

Medicaid has similarly concentrated health care costs. For example, as DeMatteis explained, people eligible for both Medicare and Medicaid (the “duals”), are 13% of Medicaid enrollees, but account for about 35% of program costs.

People who rely on Medicaid are people you know

Most people either know someone on Medicaid or have a frequent encounter with someone who relies on the program. Families USA created infographics providing examples of the types of people we all interact with who might benefit from the Medicaid expansion. Below is a portion of their infographic for Florida which clearly shows retail sales clerks, fast food workers, hotel desk clerks, library assistants and taxi drivers as just a few of the types of working adults whose income is low enough for them to qualify for Medicaid.

Familiarity with Medicaid and real-life stories are key

Salo, even with all of his deep expertise in the details of Medicaid, reminded patient advocates, and all of us what matters when talking about Medicaid. “You need to put a face on it,” he explained. In order to be effective advocates for patients as enormous Medicaid changes are being considered, it is essential to make this about real people, with real health care stories (sometimes horror stories!).

DeMatteis reminded the group of the “power of the anecdote,” to counter myths and false narratives, especially around who benefits from Obamacare.

My tips for advocates were similarly focused. To change people’s minds and to write better policy, we need to always keep in mind that this is about real people, first and foremost, with real health care needs. We built this system because a patient needed actual health care services. Let’s make sure that in our efforts to get rid of what isn’t working in Obamacare, we don’t throw the patient out with the repeal bathwater.