Regional Roundup: ACA Updates

A snapshot from each of the six states in our region about what is happening with health care reform.

Health Care Access a Challenge for Children with Disabilities in Alaska

Alaska Governor Sean Parnell’s decision not to expand Medicaid in his FY 2015 budget proposal complicates health care access for families of children with disabilities. The Catalyst Center reports that more than a third of children and youth with special health care needs and their families experience underinsurance. The challenges of Alaska’s climate, geography and workforce shortages further complicate health care access. Says one parent with two adopted sons who experience disabilities along with anxiety and behavioral issues, “We had to seek care from private providers outside the Indian Health Services to access services. Related to the Affordable Care Act, it was hard to see how any of the plans would be considered affordable. If we didn’t have TEFRA* our boys wouldn’t receive the care they need, or we would go under financially.”

* A Medicaid program designed to help the parents of children with disabilities.
Contributor: Virginia Miller, Assistant Professor of Public Health at the University of Alaska Anchorage

Advocates of Medicaid Expansion In Idaho Cite Economic Benefits

Idaho’s legislature and governor elected not to expand Medicaid in their state. Now many Idaho public health and advocacy organizations are calling for a reversal of that decision. Idaho has the highest per capita rate of minimum wage jobs in the United States, and about 15 percent of Idaho’s population lives below the federal poverty level. Under Medicaid expansion, the federal government would cover all costs of the expansion until 2016, after which time the payments would be reduced gradually until 2022 when the State of Idaho would become responsible for a maximum of 10 percent of the costs. Advocates of Medicaid expansion argue that this cost shift to the Federal government would result in net savings for the Idaho taxpayers in the amount of $400 million over the 10-year period. Furthermore, they say the increased federal payments to local medical service providers could inject about $8 billion into Idaho’s economy.

Contributors: Padma Gadepally, graduate student in the Department of Community and Environmental Health at Boise State University; Uwe Reischl, Professor, Department of Community and Environmental Health at Boise State University; Stephen Weeg, Board Chair of the Idaho Health Insurance Exchange

State Innovation Model testing in Oregon

In April 2013, Oregon was one of six states to receive a 42-month State Innovation Model testing award from the Center for Medicare and Medicaid Innovation. The total amount awarded to Oregon is $45 million. The Public Health Division of the Oregon Health Authority (OHA) is using $5 million of these funds to integrate population health with the state’s health system transformation efforts.

This integration includes enhanced surveillance capacity through a Behavioral Risk Factor Surveillance System (BRFSS) survey of Medicaid members and a BRFSS race/ethnic oversample. OHA will also augment a public health database for community health assessments and administer a $1.8 million grant program that supports four consortia that are implementing evidence-based population health programs. Each consortium is a joint effort of local public health authorities and Medicaid Coordinated Care Organizations.

Contributor: Cara Biddlecom, Health System Transformation Policy Lead, Public Health Division, Oregon Health Authority

Montana ACA Debate Stimulates Competing Initiatives

Two ballot initiatives on the November 2014 ballot—I-170 and I-171—show divergence of thought about the ACA in Montana. Initiative 170, the “Healthy Montana Initiative” favors Medicaid expansion. I-170 asserts that Medicaid expansion will create 12,000 jobs in Montana and will provide $1.4 billion to the state economy through federal funds. Expansion of Medicaid would provide health coverage to approximately 70,000 Montanans.
Initiative 171 is in opposition to Medicaid expansion and the ACA in general. It prohibits the state from “using funds, personnel, or other resources to administer or enforce the Affordable Care Act.” This Initiative also includes language assuming that the federal government will halt all federal health funding based on noncompliance with the ACA and cites the total cost to the state at $2.83 billion due to lost federal revenue.

Contributor: Kathryn Fox, adjunct faculty for the University of Montana’s Master of Public Health program. Language of ballot initiatives: sos.mt.gov

Tribes Successfully Expand Insured Population

A successful example of a tribal program using Medicaid expansion is in the Swinomish Tribal Community, in Skagit County, Washington. Within the first 90 days of implementing a Medicaid Eligibility Assistance program, the tribe reduced its uninsured population by 45 percent by enrolling newly Medicaid-eligible individuals. Similar results have been seen with the Quinault Tribe and Port Gamble S’Klallam Tribe, also in Washington State. These tribes have developed and implemented plans to use benefits coordinators to assist in enrolling and eligibility for Medicaid or the health insurance exchange.

Contributors: John Stephens, Programs Administrator for the Swinomish Indian Tribal Community; Amanda Gaston (Zuni Pueblo), Project Manager at the Northwest Portland Area Indian Health Board

Washington Creates State Health Care Innovation Plan

In 2012, Washington received a State Innovation Models Pre-Testing Award from the Center for Medicare and Medicaid Innovation. The grant funded extensive analysis and stakeholder engagement around the topics of universal access, improved quality, and greater efficiency in Washington’s health care delivery and financing system.

The result? A State Health Care Innovation Plan, which calls for three main strategies:

1. With state government leading other purchasers, move away from fee-for-service to health outcomes payment and toward greater price and quality transparency.

2. Work at the state level and with communities to shape policies that bridge disparate systems (e.g., physical and mental health, public health, education, community development) and promote “upstream,” health promoting actions; create “accountable communities of care” to focus regional capacity for this effort.

3. Integrate mental health, substance abuse, and primary care services to improve health outcomes for people with chronic, complex needs.

To be implemented, the Innovation Plan will require additional funding, but may bring estimated savings of $730 million over a three-year period.

Contributor: Aaron Katz, Principal Lecturer, Department of Health Services, University of Washington School of Public Health

Wyoming Seeks to Insure More Children

With ACA implementation, Wyoming Medicaid expected to see a large increase in children covered by health insurance. So far, that increase has not yet materialized. Projections had estimated that by 2016 the ACA would stimulate average enrollment to grow by 12 percent to 15 percent by adding 6,900 newly eligible children and approximately 1,800 children that were already eligible but not enrolled. But as of March 2014, there were 48,660 children enrolled in Medicaid or CHIP, slightly fewer than the 48,693 children enrolled at the same time last year. It is possible that Wyoming’s improving economy may be diluting the impact of the ACA.

Contributor: James Bush, Medicaid Medical Health Officer, Wyoming Dept. of Health