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State Integration for Dual Eligibles


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State Integration for Dual Eligibles

  1. 1. A not-for-profit health and tax policyresearch organization State Integration for Dual Eligibles Grace-Marie Turner November 30, 2012 Galen Institute /GalenInstitute
  2. 2. Majority of Americans Oppose Government Health Care Gallup asked: Do you think it is the responsibility of the federal government to make sure all Americans have healthcare coverage, or is that not the responsibility of the federal government? % Government responsibility % Not government responsibility 69 64 64 64 62 62 59 58 54 54 50 50 50 47 47 46 44 41 39 38 34 35 34 33 31 28 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2012 2011 2012Source: Jeffrey M. Jones, “Now Against Govt Healthcare Guarantee,” Gallup Politics, November 28, 2012,
  3. 3. An ObamaCare State ExchangeSource: Sarah Kliff, “Is ObamaCare too much work for the Obama administration?” The Washington Post, November 12, 2012,
  4. 4. Some
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  6. 6. Medicaid swamping state budgets PERCENT OF BUDGET SPENT ON MEDICAID, FY 2008 Source:
  7. 7. Source: Avik Roy, “How Do Blue States Expand Medicaid? By Paying Doctors Less,” Forbes: The Apothecary, July 23, 2012,
  8. 8. Medicaid Dual Eligibles: Enrollment and Spending, FFY 2007 Medicaid Enrollment Medicaid Spending Premiums 4% Medicare Acute 6% Adults Other Acute 25% Other Aged & Disabled 2% 10% Duals Non-Dual 15% Spending Long- Dual 60% Term Care Spending Children 27% 39% 50% Prescribed Drugs 0.4% Total = 58 Million Total = $311 BillionSOURCE: Urban Institute estimates based on data from MSIS and CMS Form 64, prepared for theKaiser Commission on Medicaid and the Uninsured, 2010.
  9. 9. Agreed: We need coordinated care for Duals • Duals are the most costly of Medicaid patients • The sickest patients often receive the worst care, with little or no coordination • Moving Duals into managed care needs to be done carefully to make sure they receive coordinated care and access to needed treatments and
  10. 10. Analysis of CA Dual-Eligible “pilot”…• Too many enrollees to be a test project• Enrollment process doesn’t protect beneficiaries• Lower-quality plans selected for price; little experience in complex care delivery.• Losing access to regular physicians, exacerbating continuity of care problemsLetter to Melanie Bella, Director, Medicare-Medicaid Coordination Office, June 29, 2012. National Senior Citizens LawCenter,
  11. 11. Prescription Drug Coverage Among Medicare Beneficiaries, 2010 No Drug Coverage Stand- Alone 4.7 Prescription million Drug Plan Other Drug 10% (PDP) Coverage1 5.9 million Total in 17.7 Part D 13% million 38% Plans: 27.7 Million 8.3 (60%) Retiree Drug million Coverage2 18% 9.9 million 21% Medicare Advantage Drug Plan Total Number of Medicare Beneficiaries = 46.5 MillionNOTES: Numbers do not sum to 100 percent due to rounding. 1Includes Veterans Affairs, retiree coverage without RDS, Indian Health Service, state pharmacyassistance programs, employer plans for active workers, Medigap, multiple sources, and other sources. 2Includes Retiree Drug Subsidy (RDS) and FEHBP andTRICARE retiree coverage.SOURCE: Centers for Medicare & Medicaid Services, 2010 Enrollment Information (as of February 16, 2010).
  12. 12. Eligibility and Participation in Medicare Part D Low-Income Subsidies, 2009 Eligible but not receiving subsidy 2.3 million 19% Eligible but estimated to have other drug coverage 0.5 million (4%)1 Full dual eligibles 6.3 million automatically 50% receiving subsidy 1.5 million Applied for and receiving subsidy 12% Future anticipated facilitated enrollment = <0.1 million (0.1%) 1.8 million 15% MSP and SSI recipients automatically receiving subsidy2 Medicare Beneficiaries Eligible for Low-Income Subsidies, 2009 = 12.5 millionNOTES: 1Includes Veterans Affairs, Indian Health Service, and Retiree Drug Subsidy (RDS) coverage. 2MSP is Medicare Savings Program; SSI isSupplemental Security Income.SOURCE: Centers for Medicare and Medicaid Services, 2009 Enrollment Information (as of February 1, 2009)
  13. 13. Defined contribution – template for reform • Long-term Medicare – and Medicaid – reform relies on giving people choices of private competing plans • Medicare Part D is a prime example of how to increase choice and save money for taxpayers and seniors – Spending is 46% less than projected! • Undermining the Part D competitive model is bad for seniors in restricting access to drugs and for our future prospects for entitlement
  14. 14. Why ObamaCare Is Wrong for America How does the health care law drive up costs? Is your doctor really in charge of your health care decisions? Are your Constitutional rights threatened? Discover the law’s impact on your life in a new book from four nationally recognized health policy experts Published by Broadside Books, an imprint of HarperCollins
  15. 15. Grace-Marie Turner Galen Institute A not-for-profit 703-299-8900 health and tax policyresearch organization Subscribe to our free email alerts at /GalenInstitute