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Benjamin Sommers, "Health Care Reform: Medicaid"


Published on

December 12, 2017

The Sixth Annual Health Law Year in P/Review symposium featured leading experts discussing major developments during 2017 and what to watch out for in 2018. The discussion at this day-long event covered hot topics in such areas as health policy under the new administration, regulatory issues in clinical research, law at the end-of-life, patient rights and advocacy, pharmaceutical policy, reproductive health, and public health law.

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Benjamin Sommers, "Health Care Reform: Medicaid"

  1. 1. Evidence on Medicaid and the ACA Petrie-Flom Center Benjamin Sommers, M.D., Ph.D. Harvard T.H. Chan School of Public Health December 2017
  2. 2. Plan for Today • Short presentation on research evidence to date on the ACA’s Medicaid expansion • Effects of ACA’s Medicaid expansion: – Patients – Hospitals – State budgets – Alternative models of expansion • Politics of Medicaid reform 2
  3. 3. Medicaid Expansion: Coverage 3 Source: Sommers, Gunja et al., JAMA 2015
  4. 4. Medicaid Expansion: Coverage • CMS statistics: – 16.1 million more enrollees in Medicaid/CHIP as of 8-2016, compared to 9- 2013 • Survey estimates: – Roughly half of gains were pre-ACA eligible (‘woodwork’), other half were part of ‘early expansions’ or 2014 newly-eligible – Uninsured rate for low-income adults fell by 5.2 percentage points from expansion 4 Sources: CMS 2016; Sommers et al, JAMA 2015; Frean, Gruber, Sommers JHE 2017.
  5. 5. Medicaid Expansion: Better Access & Affordability 5 Source: Commonwealth Fund, “In the Literature,” Adapted from Sommers et al., JAMA Int Med 2016 Changes from 2013 to 2015 after Medicaid expansion in two states (KY and AR), compared to no expansion (TX)
  6. 6. Quality of Care and Health 6 Source: Sommers, Orav, Blendon, & Epstein, JAMA Internal Medicine, 2016
  7. 7. Medicaid Expansion: Increased Prescription Drug Use 7 Notes: “Rx per capita” is per non-elderly adult in the state (not just Medicaid beneficiaries). Source: Ghosh, Simon, and Sommers 2017 NBER Working Paper
  8. 8. Private Option vs. Medicaid: Both Beneficial, Few Differences -35% -25% -15% -5% 5% 15% Excellent self-reported health Fair/Poor quality care Diabetics Glucose Check Check-up Regular care for chronic conditions Annual out-of-pocket spending* Trouble paying medical bills ED is usual source of care Skipped prescription due to cost Cost-related delay in care Personal doctor Usual source of care Medicaid Private Insurance Uninsured MEDICAID EXPANSION PRIVATE OPTION Notes: Bars show difference-in-differences comparison, relative to non-expansion (Texas). * Outcome is Log(Spending), with estimate reported as percent change. All other estimates are percentage- points. P-value, AR vs. KY 0.28 <0.001*** <0.001*** 0.08* 0.08* 0.26 0.99 0.22 0.33 0.05** 0.50 0.49 0.05** 0.42 0.94 Source: Sommers et al. JAMA Internal Medicine, 2016
  9. 9. Medicaid Expansion: Reduced Hospital Uncompensated Care 9 Source: Nikpay et al. Health Affairs, 2016
  10. 10. Expansion Budget Effects 10Source: Sommers & Gruber, Health Affairs 2017
  11. 11. Budget Effects, FY 2010-2015 11Source: Sommers & Gruber, Health Affairs 2017
  12. 12. Red States and ACA Repeal 12 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Arkansas Kentucky Louisiana Texas Helped by ACA Hurt by ACA 1,570 adults 19-64 with incomes < 138% of poverty were asked in Nov-Dec 2016: “So far, would you say the health care law has directly helped you, directly hurt you, or has it not had a direct impact?” Source: Sommers & Epstein, NEJM 2017
  13. 13. Medicaid is Actually Popular 13 Source: Barnett & Sommers JAMA IM 2017 – using National Medicaid CAHPS Medicaid Enrollees’ Health Care Satisfaction Ratings, 2014-2015
  14. 14. Thank you! 14