Medicaid ‘Buy-In’ Could Be a New Health Care Option for the Uninsured
Even as calls for "Medicare for All" grow louder among
Currently, Medicaid recipients pay for their coverage in only a handful of states, and the buy-in plans that states are considering might not offer the full range of benefits available to traditional beneficiaries. But advocates say the policies might be an appealing option for people hard-pressed to pay for plans on the health care exchanges, and spur competition that could lower prices for everybody.
The concept of enrolling all Americans in Medicare, the federal health insurance program for the elderly, is probably a nonstarter in politically polarized
"We think 2019 is going to be the year of Medicaid buy-in," said
In
Studies of a buy-in option also are ongoing in
And, a soon-to-be released survey commissioned by
In some states, it already is.
"Things aren't happening at the federal level, so states are saying, 'Let's see what we can do,'" said
Just this week,
In
In
But some lawmakers have concerns about Medicaid buy-in plans.
"Local hospitals and providers will go out of business because they won't have the money they need" because of the low Medicaid reimbursement rates to medical providers. He said proponents haven't identified how they would raise the money to support such a plan.
Many Options
As states wrestle with the task of trying to create Medicaid buy-in plans, they confront a myriad of options, which explains why many of them have launched studies.
Each state has numerous questions to answer: Who would be eligible to buy into the Medicaid plan? Would it be open to all comers or perhaps a more targeted population, such as those below a certain income level? What benefits would be offered -- the same as those offered to other Medicaid beneficiaries, fewer or more? Would the buy-in plans be offered on the current Affordable Care Act exchanges, in which case, unlike current Medicaid plans, they would have to be ACA-compliant?
Other questions abound. How much would premiums, deductibles and other cost-sharing fees be? And who would administer the buy-in plans -- existing Medicaid agencies, some other state agency or a new entity?
Looming over those questions is how the Trump administration would view Medicaid buy-in plans, which might require federal approval, depending on how states craft them.
Securing that permission could have a far-reaching impact on who might benefit from a buy-in plan. The plans wouldn't be eligible for the federal matching funds provided in traditional Medicaid. But with Trump administration approval, low-income consumers (those with incomes between one and four times the poverty level) who are eligible for federal subsidies on health insurance exchanges could use that money to pay premiums for Medicaid buy-in plans.
"Proposals such as Medicaid buy-ins, while well-intentioned, often lack important policy and programmatic details,"
Medicaid buy-in plans theoretically could provide health coverage more cheaply than commercial plans for several reasons: They aren't profit-making enterprises, they would benefit from Medicaid's economies of scale, and they likely would reimburse providers at a lower rate than either commercial insurers or Medicare do.
"I doubt that states with an ideological opposition to expansion would have any more interest in this," Holahan said.
Oregon Rep.
"Depending on how that would be set up, it's certainly not a subject that I'm adamantly opposed," he said. "But I'd like to see the structure."
Spurring Competition
The legislation passed in the Democratic-controlled legislature but was vetoed by Sandoval, who was succeeded this week by a Democrat,
While premium prices did not rise dramatically for Nevadans on the health exchange this year, Sprinkle said they remain too high for many in the state, particularly in rural areas where consumers only have one insurance carrier.
Sprinkle said his bill would open Medicaid to anyone whose income is above 400 percent of poverty (
"Because it wouldn't be profit-driven, it would provide a level of stability that the market doesn't have now. People want to know their health insurance is going to be stable for the next three, four, five years so they can plan for it," he said. "This would provide that."
In
Last year, the legislature called for a study of the idea. A consulting company evaluated four types of buy-in plans, with a range of targeted populations and benefit packages, and whether federal approval would be required.
In the end, the consultants recommended that the state pursue the least ambitious choice, one with the smallest targeted population and that would not require federal approval. "They said, 'Let's be realistic; you're not going to get a waiver from the Trump administration,'" said State Sen.
Now being analyzed for costs by
"If we can get it on the books, it'll become the foundation for even broader efforts in the future," he said.
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