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Medicaid costs skyrocketing

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Illinois

* The Tribune reports that far more people have signed up for Medicaid than expected and costs per person are skyrocketing…

Starting in 2017, Illinois and other states that also expanded their programs are required to start paying a small portion of the bill, rising to no more than 10 percent of the total tab. State health officials estimated in 2012 that Illinois’ portion of the expansion would cost $573 million from 2017 through 2020.

But far more people signed up in 2014, the expansion’s first year, than the state expected. Based on multiple interviews and a Tribune analysis of government data, Illinois will pay at least $907 million from 2017 through 2020 because of those new members. The tab could surge even higher, though.

A document sent by Quinn’s office to the federal government over the summer significantly raised the per-person estimated cost, bumping the state’s total outlay to $2 billion, using 2014 enrollment numbers, more than three times the original estimate. […]

Original projections anticipated that 199,000 residents would sign up in 2014, potentially rising to no more than 342,000. State officials estimated a monthly, per person cost of $454, and revised that number upward to $882 in the document sent to in June to federal officials.

But through December, 540,877 joined Medicaid’s ranks. State officials said thousands more likely signed up through January.

Oy.

* A chart…

* The Tribune editorial board wants the state to impose fees…

Gov. Mike Pence of Indiana in recent days announced an expansion of Medicaid, with a twist. The Republican governor secured the approval of the Obama administration to require that Medicaid enrollees chip in a small contribution — up to around $26 a month for a single adult — for their health care premiums. If people fail to make the payments, they could be denied coverage for six months.

The deal also discourages unnecessary trips to the emergency room — an expensive item in every Medicaid budget — by imposing copays of up to $25 for patients who make unnecessary trips.

Pence’s plan will provide health care to as many as 350,000 people, and set a new model for responsible use of that health care.

Discuss.

posted by Rich Miller
Tuesday, Feb 3, 15 @ 9:28 am

Comments

Another Quinn Administration fiscal booby trap. Those budget people did a bang-up job didn’t they?

Comment by Cassiopeia Tuesday, Feb 3, 15 @ 9:33 am
I think I support the idea of an ER co-pay. But the fee for health care doesn’t make sense — if a person can’t pay and loses coverage, s/he will just wind up in the ER with no insurance. That hurts the hospital and costs the state much more money.

Comment by Soccermom Tuesday, Feb 3, 15 @ 9:35 am
It defeats the purpose of health care reform to start charging poor folks a fee to enroll. And really, what is the point of charging a $26 fee out of $882? I assume that is a sliding fee, so it slides down to what, $10?

If you are going to deny coverage based on the fee requirement, you have to have a separate appeals and waiver process. This is a great way to pad the payroll with paper pushers over at the Dept. of Health and Family Services, but I can assure you that $26 per person is not going to cover the cost of their salary, health care and pension benefits.

Tribune editorial board with another swing-and-a-miss. Stop taking your cues from Team Rauner and start thinking things through.

If you want to save money, you need to move from a sick care model to a well care model. Prevent heart disease, learning disabilities, cancer. That is where the real savings is.

Comment by Juvenal Tuesday, Feb 3, 15 @ 9:37 am
Agreed Soccermom.

Comment by PublicServant Tuesday, Feb 3, 15 @ 9:37 am
Shocking.

This is quite a miss, though. When you’re off by that much…

Comment by Formerly Known As... Tuesday, Feb 3, 15 @ 9:42 am
Donna Arduin has plans for this lol. The middle class & poor are going to have it rough this year.

Comment by foster brooks Tuesday, Feb 3, 15 @ 9:43 am
Good points, Juvenal. If Rauner is serious about saving money (rather than demonizing poor people), HFS should start a serious health promotion campaign for folks on Medicaid.

Here at my current place of employment (did Soccermom mention she is looking for a job?), we get reduced insurance premiums and other extras if we participate in the organization’s health promotion program. It would almost certainly make good fiscal sense to create something similar for Medicaid.

Rauner would have to bite the bullet and hire some extra people to run the program, but there are lots of good, smart public health advocates who would love a chance to help people on Medicaid regain their health.

Comment by Soccermom Tuesday, Feb 3, 15 @ 9:45 am
But any Medicaid cuts will be compassionate!

Comment by Norseman Tuesday, Feb 3, 15 @ 9:48 am
An Emergency Rm Co pay makes sense. A small monthly charge is fine. When you pay for something it is more appreciated instead of just another hand out. Medicaid is a huge chunk of the budget it will be interesting how Rauner tackles this. The bad estimates just another glaring example of the Quinn Incompetence.

Comment by fed up Tuesday, Feb 3, 15 @ 9:48 am
The Indiana fee is a fig leaf to give Pence political cover for buying into Obamacare. The $26 fee is the max; it can be low as a buck.

More GOP governors will use the fig leaf now to get their people enrolled. Their hospitals have been howling for it.

Who would pay administration costs to collect, or kick people out of health insurance coverage, over five bucks or so a month? It just protects the GOP guvs right flanks.

You’re going to pay one way or the other, either in Mediciad or in the costs of the uninsured being rolled into what they charge those who are insured.

Comment by Wordslinger Tuesday, Feb 3, 15 @ 9:49 am
Medicaid in Illinois already has copays for ER, meds, office visits etc. We have gone to managed care to capitate and control costs. I am more curious as to why the big increase in the per person cost. If that is averaging out the cost for Managed Care and the areas that are fee for service or that we did not get good capitation rates negotiated or a mix of all.

Comment by illlinifan Tuesday, Feb 3, 15 @ 9:51 am
While it is nice that some here see it a big problem when we expect a poor person to pay $26 towards their visit, you need to see it is a big problem for everyone else to pay what you think those poor cannot.

It is important that everyone contribute into the system to keep it sustainable. That $26 is about the cost of their family’s McDonalds dinner. They can do it.

Comment by VanillaMan Tuesday, Feb 3, 15 @ 9:53 am
A state cost of $907m means the Federal Govt. will provide $8.1 bn if all of this is for the Medicaid expansion. Which it isn’t.

But whatever the number, that’s money that goes towards hospitals, doctors, care givers, maintenance personnel and suppliers. It helps to create a strong and stable medical infrastructure as well as tax receipts.

The Tribune’s analysis is short sighted and shallow. Nothing new there.

Comment by MikeMacD Tuesday, Feb 3, 15 @ 9:54 am
The $26 is interesting. In some cases people place more value on something they pay for. I wonder if there is any research to indicate that a nominal fee for participation in Medicaid has some sort of benefit (other than a minor cost offset for the state).

The bigger picture here is that people really want health coverage. As Congress prepares to cast another vote to toss out the ACA, I wonder if they have a replacement in mind. (LOL, I don’t really wonder that.) It would seem to benefit everyone if we made a switch to “Medicare for All.” The demand is there, and the ability of a single payer to control costs would be a big help to the state’s bottom line. The shift would not be easy, but the long term benefit would probably be worth it.

Comment by Pot calling kettle Tuesday, Feb 3, 15 @ 9:55 am
This information was available to the public last June.

This is part of the PR case being made that the budget is worse than we all knew. Hard to judge whether someone on the Rauner team should have known this for months. Someone following healthcare spending and policy closely would have.

That said, missing the enrollment forecast by over 50% was a serious error. The financial impacts should have been in the press long before now. Assume that the numbers of those who applied for ACA and were directed into Medicaid were much bigger than expected.

Comment by walker Tuesday, Feb 3, 15 @ 9:56 am
Perhaps Illinois will advocate the “Luck” plan as a serious alternative rather than a tongue in check alternative.

Comment by Bill White Tuesday, Feb 3, 15 @ 10:04 am
Not sure the $26 wouldn’t be eaten up by the extra costs required to administer it. As a signal to figure out a way to get care without ER visits, it might have some value. We certainly need more Medicaid-focused community healthcare providers for that to work.

For those in truly dire straits, it would be net harmful.

Comment by walker Tuesday, Feb 3, 15 @ 10:05 am
==Those budget people did a bang-up job didn’t they?==

==The bad estimates just another glaring example of the Quinn Incompetence==

You can only make projections based on history and try to anticipate the impact of these expansions. I’m glad you are perfect and have a crystal ball and can predict this kind of stuff. Dopes.

Comment by Demoralized Tuesday, Feb 3, 15 @ 10:09 am
== Based on multiple interviews and a Tribune analysis of government data, Illinois will pay at least $907 million from 2017 through 2020 because of those new members. ==

$907 million divided by 4 (2017, 2018, 2019 & 2020) is $226 million per year.

Watch the hospitals and doctors scream if Illinois passes up billions in federal aid to “save” $226 million per year.

Comment by Bill White Tuesday, Feb 3, 15 @ 10:13 am
== Not sure the $26 wouldn’t be eaten up by the extra costs required to administer it. ==

Drug testing welfare recipients costs more in bureaucracy that it saves and yet some find it an emotionally satisfying policy.

Comment by Bill White Tuesday, Feb 3, 15 @ 10:14 am
===That $26 is about the cost of their family’s McDonalds dinner.===

Or a week’s worth of food from a grocery if you spend it wisely, and if there is a decent store in your neighborhood.

But thanks for inserting a tired old stereotype of poor people eating every meal at McDonald’s. What, aren’t you clever enough to mention that $26 is less than the poor family’s cable bill?

Try harder VMan.

Comment by Anonymous Tuesday, Feb 3, 15 @ 10:32 am
Yeah, that was me at 10:32.

Comment by 47th Ward Tuesday, Feb 3, 15 @ 10:33 am
How many times did House and Senate Rs bring this exact problem up in debate? Too many to count. But they were just written off as anti-Obamacare.

Comment by Tree Stand Tuesday, Feb 3, 15 @ 10:37 am
==you need to see it is a big problem for everyone else to pay what you think those poor cannot.==

Well said Ms. Arduin. That is you, right?

What the heck have poor people done to some of you to make you have such a flippant attitude toward them? It’s pretty pathetic.

Comment by Demoralized Tuesday, Feb 3, 15 @ 10:39 am
I think this demonstrates the need for universal single payer health coverage for all, like most developed countries. Health care should be part of the Commons and health insurance companies should not be in the middle between the payments and the providers.

Comment by independent Tuesday, Feb 3, 15 @ 10:40 am
Given their track record of misinterpreting numbers I shouldn’t be surprised by this. Equating a number put in a waiver application for the purpose of federal negotiations with the actual pmpm for the Medicaid program is misleading at best. Also, costs for the long-term care population are much higher than those for people coming in under the Medicaid expansion.

Comment by Fun with Numbers Tuesday, Feb 3, 15 @ 10:44 am
Wait until the federal government starts to change the formula in a few years and the state’s get stuck with a much bigger bill. There is no free lunch!

Comment by Apocalypse Now Tuesday, Feb 3, 15 @ 10:46 am
==But they were just written off as anti-Obamacare.==

Not just anti-Obamacare. Anti-poor, hateful people.

The name calling and the holier than thou attitude by some really crossed the line.

Comment by Formerly Known As... Tuesday, Feb 3, 15 @ 10:49 am
So if you are disabled and your only source of income is SSI, do you pay half your monthly income back to the state?

What if you are seriously mentally ill and out of work, yet you have a co-pay on Medications, where does this come from?

Comment by SSF Tuesday, Feb 3, 15 @ 10:52 am
Okay. here’s the thing. When a sick person without insurance shows up at the emergency room, we all pay. WE ALL PAY. That’s why a tylenol in the hospital costs $10. And because the hospitals have to inflate their costs to cover uncompensated care, they charge our insurance companies more. those costs are passed on to us.

I support health coverage for the impoverished for moral reasons. I live in the most affluent country in the world, and it makes me feel sick when i see homeless people with missing limbs because they did not get early treatment for diabetes.

But apart from any considerations of morality or fundamental fairness, increased health coverage saves money for all of us. It’s a lot cheaper to provide prenatal care than it is to keep a premature baby in the nicu for a few months. Or are you suggesting that we let poor babies die if their parents can’t pay a $500,000 medical bill?

Comment by Soccermom Tuesday, Feb 3, 15 @ 11:02 am
@TreeStand: You know, that’s a good comment at 10:37.

Many R’s in the House and Senate did say that the costs would be much higher than projected for the Medicaid portion of this, but I recall some of their numbers being thrown out as five, or even ten times as much, rather than the 50% over, that actually occurred.

Of course they were right to be cautious, and the best forecast would have been in between the two sides. But their extreme arguments and disaster predictions lost credibility, and unfortunately reduced our ability to arrive at the right number.

Comment by walker Tuesday, Feb 3, 15 @ 11:03 am
so Medicaid isn’t just “free money” from the federal government?

Comment by Ahoy! Tuesday, Feb 3, 15 @ 11:04 am
==Or are you suggesting that we let poor babies die if their parents can’t pay a $500,000 medical bill?==

Well, yeah, some are. They just don’t see it that way. They complain about “takers” and how it’s not their responsibility to have their money “taken” from them to give to those lazy poor people.

People wonder why we aren’t really a Christian nation. That attitude is why. I call it the “screw you, I’ve got mine” attitude.

Comment by Demoralized Tuesday, Feb 3, 15 @ 11:33 am
This from those raging socialists at Bain.

https://pbs.twimg.com/media/B878ZcxIQAAoNYz.png:large

Comment by Soccermom Tuesday, Feb 3, 15 @ 11:53 am
I think that Obamacare or any other health insurance expansion is a work in progress. Rather than not helping poor people at all, we can work toward finding the most affordable care for our fellows. It’s almost too much to ask politically, since government help with insurance is red meat to the right wing base, and since multibillionaires and other very wealthy people will pour nearly a billion dollars in the 2016 elections to fight Obamacare.

That’s one thing I like about Obamacare, that it has a waiver to allow states to implement Medicaid expansion after their political environments.

If we can spend trillions of dollars in the long run because of the Iraq War, surely we can make health insurance expansion a priority for our people.

Comment by Grandson of Man Tuesday, Feb 3, 15 @ 11:54 am
That June 2014 1115 waiver proposal is/was DOA. It was hastily crafted together by consultants hired by Quinn and ignored much of the input from HFS. None of the numbers from that proposal should be used to compare anything. Those costs are highly inflated.
Illinois will see little direct cost reduction from switching to Managed Care. Our rates were so low that managed care companies have little room for savings on the provider side, they must control utilization and develop care plans for the recipients.
There are some co-pays required now, but they are so low that many providers just ignore them.
The feds are paying the freight on the new ACA enrollees now, if we can keep them healthy we can hope theu don’t morph into disabled adults that cost Medicaid a fortune.
Don’t forget there is $2 Billion in supplemental payments going from Medicaid to Illinois hospitals now. The ACA Medicaid expansion should be a boon to the Cook County Health System.

Comment by LTSW Tuesday, Feb 3, 15 @ 12:16 pm