Improved Medicaid for All
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Medicaid Still Unwinding
Medicaid is federally and state funded health insurance for low income Americans. It is like 50 different health insurance programs administered by the 50 states. Medicaid was expanded during the pandemic. It helped make sure that those who needed care could get it and that when they had healthcare transmission rates would be kept down. Good policy. Better policy is if everyone had healthcare, like our peer industrialized nations.
Well, the pandemic is over, legally, and so Medicaid is having everyone reapply. No reapplications were necessary during the pandemic to make sure everyone kept their coverage. Many are expected to lose their coverage. As of today it is about 1.6 million dis-enrolled in 27 states and D.C. The Kaiser Family Foundation estimates it could go as high as 24 million.
Medicaid Providers
Medicaid Background
While we are on the subject, The Kaiser Family Foundation has done an analysis of who is providing Medicaid services. Remember that Medicaid is the health insurance program for low income people and children (CHIPS for Children) and is administered differently in every state. The Federal government pays most of the cost with a much smaller portion covered by the states. Some states include a tax on hospital services to bolster their funds. Also, recall that the ACA offered additional funding to states that would increase their Medicaid eligibility for those whose income was up to 138% of the federal poverty level. Here are the 13 states that refused to do so. Alabama, Florida, Georgia, Kansas, Mississippi, Missouri, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming.
At the height of the pandemic 90 million of us received healthcare from Medicaid. That’s 27% of the US population.
Medicaid Profit Engine
40 states contract with managed care organizations (MCO) to provide medicaid services. MCOs are a type of health plan that includes a group of doctors and other providers who work together to provide health services to its members. MCOs cover all Medicaid services, including doctor visits, behavioral health services, nursing facility services, and "waiver" services for community-based long term care.
MCOs are the predominant form of Medicaid managed care. Each state contracts separately with MCOs, although many MCOs operate in multiple states.
Two thirds of Medicaid patients (about 57 million people today) get their coverage from managed care organizations. Five for profit publicly traded companies serve 50% of those patients. Just 5. That comes to 28.5 million people and that’s 8.6% of the whole US population. They are Centene (22%), Anthem (11%), United Health Group (9%), Molina (5%), Aetna/CVS (3%). All of these 5 operate in 12 or more states.
Elsewhere there are 142 other MCOs managing the other half of the Medicaid MCO market.
Medicaid expansion was a boon to all of these for profit companies. These same firms reported Medicaid revenue growth ranging from 13% (Centene) to 16% (UnitedHealth) to 43% (Molina) year-over-year 2021 over 2020. Molina reported the medical margin earned by the Medicaid segment was $3.0 billion in 2022 and $2.3 billion in 2021 (medical margin = premium revenue – medical costs). Big business indeed.
Make it Better
Improved Medicare-for-all programs would cover a comprehensive set of health care services for adults that would eliminate the current variability in Medicaid benefit packages across states. This may seem small but it is gigantic. T. R. Reid’s book (The Healing of America) highlights this problem when a young Lupus patient winds up on Medicaid after a Lupus attack and loses her job and healthcare. Of course, the medicine that would give her a normal life was not on her state’s Medicaid formulary. It killed her.
Improved Medicare-for-all programs would establish universal national health coverage for all or nearly all U.S. residents, eliminating the need for the specific eligibility pathways in the current Medicaid program. There would also be no need to re-enroll and potentially lose coverage if you made a few extra dollars.
Would MCOs still be in place? Perhaps. Not contracted to the states as they are now but as providers with globally established infrastructure budgets that could restrain excess overhead and profits at the cost of patient health.
Here’s good news for states. No more taxes to support Medicaid.
Does Improved Medicare for All fix everything. Of course not, but it covers us cradle to grave, for what’s medically needed at far lower cost than the US pays now. That last part was evaluated by the non-partisan Congressional Budget Office.
(Repeat) Vaccines this Fall
The FDA approved two new vaccines for respiratory syncytial virus (RSV) in May 2023: GSK's Arexvy, Pfizer's Abrysvo. These will be available for those 60 and over.
COVID-19 vaccines and boosters are continually being updated as COVID-19 continues to mutate. Keep your boosters up to date!! Check with your primary physician about when to get the next one and then get it.
Flu won’t ever go away so make sure to get this one too!!
Here is a NY times article on the subject.
ACTION
Contact your elected representatives and let them know that the Improved Medicare for All can help provide consistent care for those on Medicaid with benefits that don’t vary from state to state at lower costs than we pay now. Their contact info is in the references below.
Or use Resistbot by texting SIGN PSHOIS to 50409 to send the message below.
“I am your constituent. I found out that 5 for profit, publicly traded companies are responsible for Medicaid MCOs covering 28.5 million of us. Medicaid covers different things in different places and is at least 50 different programs. Your coverage and health depends upon where you live. That’s not right. Procedures and medicines might not be available in your state because you chose the wrong state to live.
You can fix this at far lower cost by enacting HR 3421 or S 1655 Improved Medicare for all. Cradle to grave, everyone in. I need you as my elected representative to do this.”
Find My Elected Officials
Contact the White House https://www.whitehouse.gov/contact/
Contact State and Federal Representatives
https://www.commoncause.org/find-your-representative/addr/
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Our Newsletter resources including reproductive healthcare
Healthcare Advocacy Reading List
Organizations to Contact
NARAL - Pro Choice America
Planned Parenthood
Physicians for a National Health Plan
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water Resistbot write up
Alan,
I like the Monopoly graphic! So, here is a question that might have been covered elsewhere – or maybe not.
If an elected official believes that their constituency is firmly against Medicare for all? What can done to move the opinion of the voters and the official who depends upon those votes for reelection?
What is the starting point for asking that question? Maybe it’s something like a list of the wrong beliefs that people have across the political spectrum about universal healthcare not being feasible. It could be things like it would cost too much, or it would raise my taxes, or I wouldn’t be able to choose my own doctors, whether such beliefs are true or not.
My suggestion or musing, here is an attempt to find all the wrenches that have been thrown into the machinery that would otherwise work.