April 21, 2016
April 21, 2016
Wendy Patton's testimony to the Ohio Medical Care Advisory Committee.
Contact: Wendy Patton, 614.221.4505
Medicaid provides health insurance for people less than 65 years old who lack health care through their employer and cannot afford private insurance. As of March 2016, a quarter of all Ohioans were insured through Medicaid. Medicaid expansion has allowed hundreds of thousands of Ohioans who were previously uninsured and lacked affordable coverage options, to see a doctor.
Access to health care lets people see a doctor regularly and prevent illness and crisis. Preventive care, like cancer screenings and check-ups, enables illnesses to be caught and treated early, which can save costs, dramatically reduce suffering and boost opportunity for a healthy and productive life. Access to care reduces the spread of infectious disease, helping everyone in our communities, including people with private coverage. Insurance and regular care can prevent financial crisis and reduce financial burdens that people with chronic illness face. Uninsured patients who face a medical crisis are disproportionately likely to end up in bankruptcy or foreclosure. Insurance coverage through Medicaid helps prevent these financial disasters.
The “Healthy Ohio Plan” proposal asks the U.S. Secretary of Health and Human Services to waive certain Medicaid rules for non-elderly adults - about half of the Medicaid enrollment - and allow different rules. Medicaid rules may be waived under Section 1115 of the Social Security Act, which allows approval of demonstration projects that promote the objectives of Medicaid programs. Demonstration projects are supposed to increase and strengthen overall coverage of the low-income population; increase access to, stabilize, and strengthen providers and provider networks serving Medicaid enrollees; improve health outcomes and increase the efficiency and quality of care for people insured by Medicaid.
The “Healthy Ohio Plan” does not further these objectives and it should not be approved as another demonstration project. Ways in which it hinders these objectives are outlined in our testimony.
The “Healthy Ohio Plan” will require premiums of up to 2 percent of annual adjusted income for non-elderly adults, up to $99 a year or $8.25 per month. This sounds small, but for people on very limited incomes — like those on Medicaid — such costs have been found to decrease use of health care services. The U.S. Department of Health and Human Services published research in July 2015 that found increased costs make it harder for poor families to access needed health care and maintain coverage. Key findings include:
Here in Ohio, MetroHealth Hospital’s early experiment with Medicaid expansion had similar findings: The expansion of readily accessible care, without cost, enhanced health.
Research over many years shows that imposing costs on health care reduces use by poor families or results in discontinuous use. This is because they have limited income. They chose between gas, food, rent, and other bills. Health care falls to the bottom of the pile.
The “Healthy Ohio Plan” lock-out provision will reduce access to care. If someone misses two monthly payments or a paperwork deadline, he loses coverage. If he lost coverage because he couldn’t pay the premium, he must repay what he owed for prior months before regaining care. This makes regaining access more difficult.
People losing their health coverage will hurt the providers who would otherwise serve them, or do serve them but are not compensated for the care they provide. For example, if someone who has not enrolled in Medicaid because of the premium breaks a leg, Medicaid coverage will not start until the first premium is paid, so the provider who sets that leg is not paid. If the patient has been locked out of Medicaid coverage, she is even less likely to be able to cover both unpaid premiums and a re-enrollment premium. A physician or hospital will serve her, but without insurance. Growth of uncompensated care undermines an Ohio health care system that has been strengthened by insurance coverage afforded by the Medicaid expansion.
The Health Savings Account model upon which the “Healthy Ohio Plan” is based is inappropriate, because savings are premised on reduced use of health care services. The health care problem of many poor people is underuse of medical services. The conservative Rand Corporation, reviewing studies on the effect of high deductible health plans coupled with Health Savings Accounts, concluded: “While evidence suggests that the health of the overall population may not change with increased cost sharing, the health of individuals with low income and greater health care needs may decline.”
Incentive points that allow increased access to health care are given for certain activities. These features could discriminate against low-income families:
Thank you for allowing me to testify on this proposal. I am happy to answer any questions that you may have.
 Christpher T. Robertson et. Al., “Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures” Health Matrix: Journal of Law-Medicine, Vol. 18, No. 65, 2008
 Ohio Department of Medicaid, “Healthy Ohio Program 1115 Demonstration Waiver,” (Appendix 1) at http://medicaid.ohio.gov/Portals/0/Resources/PublicNotices/HealthyOhio-Detail.pd
 Office of the Assistant Secretary for Planning and Evaluation, “Financial Condition and Health Care Burdens of People in Deep Poverty,” United States Department of Health and Human Services, July 16, 2015
Robert H. Brook et.al., “The Health Insurance Experiment: A Classic RAND Study Speaks to the Current Health Care Reform Debate,” http://www.rand.org/pubs/research_briefs/RB9174.html
 Laura Dague, “The effect of Medicaid premiums on enrollment: A regression discontinuity approach,” Journal of Health Economics 37 (2014) 1-12.
 Randall D. Cebul, Thomas E. Love, Douglas Einstadter, Alice S. Petrulis and John R. Corlett, “MetroHealth Care Plus: Effects Of A Prepared Safety Net On Quality Of Care In A Medicaid Expansion Population,”.Health Affairs, July 2015 vol. 34 no. 7 1121-1130 at http://content.healthaffairs.org/content/34/7/1121.abstract
 The World Health Organization, “Chronic Disease and Health Promotion, Chapter two — Chronic Diseases and Poverty” at http://www.who.int/chp/chronic_disease_report/part2_ch2/en/
 “The Role of Medicaid for adults with chronic illnesses,” Kaiser Family Foundation, November 2012 at https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8383.pdf
 Americans are much more likely than their counterparts in other countries to say they did not visit a physician, fill a prescription, or get a recommended test, treatment, or follow-up care because of costs. In a comparison among developed nations, disparities in care between people in above-average and below-average income groups were greatest in the United States. Karen Davis, Cathy Schoen, Stephen C. Schoenbaum, Anne-Marie Audet, Michelle Doty, and Katie Tenney, Mirror Mirror on the Wall: The Quality of American Health Care Through the Patients’ Lens, The Commonwealth Fund, October 2003.
 “Analysis of High Deductible Health Plans,” RAND corporation at http://www.rand.org/pubs/technical_reports/TR562z4/analysis-of-high-deductible-health-plans.html#health
 Federal Deposit Insurance Corporation, 2013 National Survey of Unbanked and Under-banked Households at https://www.fdic.gov/householdsurvey/
 Corporation for Enterprise Development, https://cfed.org/assets/pdfs/Most_Unbanked_Places_in_America.pdf
 Workgroup to reduce reliance on public assistance: Report to Governor John Kasich and the Ohio general Assembly, April 15, 2015 at http://humanservices.ohio.gov/WorkArea/DownloadAsset.aspx?id=2147636202
 Kaiser Family Foundation issue brief (https://kaiserfamilyfoundation.files.wordpress.com/2014/09/8631-an-overview- of-medicaid-incentives-for-the-prevention-of-chronic-diseases-mipcd-grants.pdf); see also Judith Solomon, West Virginia’s Medicaid Changes Unlikely to Reduce State Costs or Improve Beneficiaries’ Health (Washington, DC: Center on Budget and Policy Priorities, May 2006) http://www.cbpp.org/cms/?fa=view&id=336. Also see Wisconsin Department of Health Services. “Do Incentives Work for Medicaid Members? A Study of Six Pilot Projects.” May 2013. Available at: http://www.dhs.wisconsin.gov/publications/p0/p00499.pdf.
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