Where are Medicaid and Medicare Going?

Where are Medicaid and Medicare Going?

For all the questions detailed questions of marketing, positioning, competitive analysis, talent management, and financial control, there are some overarching issues that healthcare executives and managers face. One of the biggest is where the money for operating and caring for patients will come from. That means looking at Medicare (healthcare for those 65 and older) and Medicaid (healthcare for the poor).

Healthcare organizations have a love-hate relationship with both programs. Many depend on the flow of money. At the same time, there is frustration over the levels of compensation and some professionals won’t offer services under one or both of the programs. But for most there’s no ignoring it.

A recent study published in the Journal of the American Medical Association suggests that Medicaid expansion has had a positive benefit on the number of people with access to healthcare, at least where the expansion was accepted, as The Hill reported.

The study compares Arkansas and Kentucky, which accepted the Affordable Care Act’s expanded Medicaid funding for people at up to 138 percent of the poverty line, to Texas, which did not.

The study finds that in Arkansas and Kentucky, people were 11.6 percentage points less likely to skip prescription medications and 14 percentage points less likely to have trouble paying medical bills, compared to Texas.

In addition, in the two expansion states, patients were 16.1 percentage points more likely to have had a checkup in the past year, and 12 percentage points more likely to be getting regular care for a chronic condition.

Interestingly, Kentucky ran the program as government-funded healthcare was worked while Arkansas channeled the federal month through private insurance. And yet, both had similar rates of success. But in 2013, extra money was channeled to increase compensation rates for the industry to encourage more participation. Then, in 2014, the additional spending ended, making the program again less financially attractive. Fewer facilities take the program, so the benefits might reverse themselves as poor people have trouble finding anyone to treat them. But getting Congress to authorize instituting higher rates on an ongoing basis would be difficult at best.

However, there may be a bit less financial pressure on Medicare, where estimates of long-term spending have dropped sharply. One of the goals of the ACA was to bring the growth of Medicare spending under control by limiting unnecessary procedures, avoiding hospital readmissions, and using preventative and regular treatment of issues to keep problems from becoming more acute.

It isn’t clear whether the trend will continue, but it offers hope that the country can find effective action to manage healthcare spending while expanding availability even without the implementation of a single-payer system.

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