Let’s open 2014 with four health policy predictions. Here are the first three:
- Obamacare enrollments will top 5 million.
- Uninsured rates will come down.
- Health inflation will tick up.
Here’s why you can
count on these.
First, 1.1 million people have already enrolled in
Obamacare. The Administration hopes for
7 million by March. That may be
optimistic, but there will be another burst of enrollments in a couple of
months. And there will be another open
enrollment period toward the end of the year.
So at least 5 million enrollments seems reasonable. And here is a bonus prediction. If that many sign up, the politics of
Obamacare in the half of the states that have embraced it will probably shift
during the 2014 election cycle. Their
people will, too.
Second, the number of people who are uninsured will go down. A 1 or 2 percent decline will be attributable
to Obamacare. The improving economy will
also help. And this means that the
numbers will be better even in the states that did not embrace Obamacare.
Third, because more people will be insured and getting care,
health inflation will go up again. Both
the Congressional Budget Office and the Administration have been predicting
this for 2014 ever since the passage of Obamacare.
In fact, if it doesn’t happen, this will probably be the health
policy news story of the year.
But the fourth
prediction may be most significant of all.
The gap will widen between the states with better health and mental health care and
those with worse.
And this has everything to do with Medicaid money.
As of December, the states
were literally divided down the middle between those that decided to expand
Medicaid in 2014 and those that did not.
If you compare the 26 states (including the District of Columbia) that decided
to expand Medicaid to the 25 states that did not, the expanding states already have
a decided advantage in supporting health and mental health care.
And with hundreds of billions more dollars flowing into
those states over the next few years, that gap will probably widen.
Consider how these Medicaid
dollars could widen the gap in just two areas – the number of nationally-ranked
hospital specialty programs in a state and mental health spending.
First, think about the high-quality hospital specialty
services we all want and sometimes need.
Hospitals rely on Medicaid dollars for a significant portion of their
revenue.
Medicaid-expanding states already have significantly more
nationally-ranked hospitals and specialty programs, according to the U.S. News
and World Report 2013-2014 rankings, than states that do not.
Seven of the ten states with the greatest numbers
of nationally-ranked specialty programs decided to expand Medicaid. And consider the advantage already enjoyed by
California (ranked #1 in number of nationally-ranked specialty programs) and
New York (#3) over the two most-populated states that decided not to expand
Medicaid – Texas (#6 in number of nationally-ranked specialty programs) and
Florida (#11).
California and New York, with 678 hospitals between them,
are home to a total of 28 hospitals with at least one nationally-ranked
specialty, with a total of 154 nationally-ranked specialties overall.
Texas and Florida, with 895 hospitals between them, are home
to a total of 16 hospitals with at least one nationally-ranked specialty, with
a total of 70 nationally-ranked specialties overall.
Texas and Florida are
leaving as much as $100 billion on the table over the next ten years, much of
which would have ended up on hospitals’ bottom lines.
The same point can be made regarding funding for care for
people with mental illnesses – on whose behalf many of those Medicaid expansion
dollars will be spent.
The 26 states expanding Medicaid already spend much more on
mental health services than those are not.
And the disparity is striking. According
to the Kaiser Family Foundation, the average state spends $120 per capita
on mental health agency programs.
But the states
expanding Medicaid spend $139, on average, compared to $116 by states that refused.
And even these spending numbers look artificially close
because of high per capita mental health spending in states like Alaska and
Maine, which have small populations.
When population size is taken into consideration, as is clear from the
pie chart above, the expanding states account for nearly twice as much of the
nation’s per capita mental health spending as do the non-expanding states.
And that gap – like the gap between the “haves” and “have
nots” – will only widen in 2014.
Paul Gionfriddo via email: gionfriddopaul@gmail.com. Twitter: @pgionfriddo. Facebook: www.facebook.com/paul.gionfriddo. LinkedIn: www.linkedin.com/in/paulgionfriddo/
Comments
Post a Comment