Medicare Compliance & Reimbursement

Report: There's no magic wand to wave at all states' uninsured rates

Under current federal Medicaid coverage expansion proposals, some states may be able to reduce their uninsured rates by more than 20 percent. However, certain proposals are more beneficial than others to certain states.
 
That's the conclusion a pair of Columbia University researchers reach in a study published June 7 as a Health Affairs Web exclusive with support from the Commonwealth Fund. In "Variations in the Impact of Health Coverage Expansion Proposals Across States," authors Sherry Glied and Douglas Gould report that the numbers of newly insured people in each state would vary under different policy proposals that are based on the income of the uninsured, existing state coverage policies
and uninsured rates, and the insurance market in the state.
 
Unfortunately, the authors write, none of the proposals can provide a panacea for all states' uninsured ills.
 
"In some states the problem of the uninsured is related to the high cost of health insurance, and in other states it is more closely linked to high rates of poverty among the
uninsured," said Glied, a professor in the Department of Health Policy and Management of Columbia's Mailman School of Public Health.
 
The report analyzed several policy proposals to expand the Medicaid benefit, and discovered that the effect of each proposal was entirely dependent on which state was up for discussion.
 
To wit: A proposal to increase coverage to include adults earning less than 133 percent of poverty would have a great impact on uninsured numbers in Alabama, Arkansas, Kansas, Kentucky, Louisiana, Michigan, Mississippi, New Mexico, South Carolina and West Virginia - but implementing this idea would have no effect on uninsured rates in Arizona, the District of Columbia, Delaware, Massachusetts, New York, Oregon, Utah or Vermont because they already cover some low-income adults.
 
Glied and Gould also found that a proposal making children in families earning less than 300 percent of the poverty level eligible for the State Children's Health Insurance Program would help states with very low SCHIP eligibility levels (Alaska, Colorado,Idaho, Montana, North Dakota, Oregon, South Carolina, Tennessee, Utah and Virginia). However, other states already have expanded eligibility to the point that they would see little change in their uninsured counts, the report states.
 
Further, a proposal that would make parents of SCHIP eligible for coverage would help cut down on the number of uninsured in states with the highest numbers
of low-income and uninsured families. But states that already cover SCHIP parents would see a negligible effect from the proposal, Glied and Gould posit.