Medicaid expansion under the ACA and Oregon's accountable care approach

Medicaid and the ACA

Discuss the issues central to the expansion of Medicaid created by the Affordable Care Act. From state policy perspective is this a good way to increase access to healthcare at a reasonable cost? Be sure to discuss the success stories you uncover as you complete your research for this question. Review the following and consider the questions below as part of your initial post.

From the State's perspective, expanding Medicaid under the ACA is a sound financial investment. However, the Supreme Court ruled that each state could decide to enter the program individually and as a consequence many states have not. These states claim that they cannot afford the program. However, a report by the Congressional Budget Office clearly shows that the Federal Government will actually be responsible for the bulk of the costs in the first decade of the program -- about 93% of the total costs.

The Congressional Budget Office (CBO) estimates that the Medicaid expansion will add very little to what states would have spent on Medicaid without health reform, while providing health coverage to 17 million more low-income adults and children. In addition, the Medicaid expansion will reduce state and local government costs for uncompensated care and other services they provide to the uninsured, which will offset at least some -- and in a number of states, possibly all or more than all -- of the modest increase in state Medicaid costs. Expanding Medicaid is thus a very favorable financial deal for states (Angeles, 2012).

The states that have expanded Medicaid have offered millions of Americans an option for affordable insurance. Even those states that have not offered expanded Medicaid programs, have still had its citizens sign up for affordable healthcare that is tax subsidized by the Federal Government in the Federal Marketplace. According to a recent Gallup survey, the number of uninsured Americans dropped from high of 18% in 2013 to a low of 14.5% at the end of March; for states that have set up their own insurance marketplaces and expanded Medicaid, the number of uninsured has dropped even lower -- to 13.6%. Those numbers will continue to decrease later in the year, with the next open-enrollment period and with more people signing up for Medicaid under the ACA's expansion provisions (Semro, 2014).

Case Study -- Health Share of Oregon: A Community Oriented Approach to Accountable Care for Medicaid Beneficiaries

What is an accountable care organization (ACO's)?

An accountable care organization is a non-profit local organization that is responsible for tying all local community assets together to improve the quality of care as well as the quality of life for its residents. Improving health outcomes can also reduce costs.

Why are states experimenting with different models of integrated care?

Most states are experience budgeting pressures in some form or another. This, coupled with the fact that more people are in enrolling in affordable care packages, makes it paramount that states find innovative solutions to providing more efficient care for its citizens.

Are ACO's a viable model to reduce the rate of growth in per-capita Medicaid spending? Why or why not?

Any system that makes more efficient and effective use of its resources is a viable alternative to doing nothing. While there may be some trial and error inherent in experimenting with new systems, there are many best practices that are being developed that can further reduce costs and refine this approach. For example, the Oregon model was able to meet all of its initial objectives and it is likely that the system will continue to improve.