• Sound Medicine: What are the benefits of an expanded Medicaid program?

    Sound Medicine is a radio show produced by the Indiana University School of Medicine and WFYI Public Radio. In the last few years, I’ve become their go-to guy on health policy. So, for those of you who would find your day brightened by the sound of my voice, enjoy the following:

    Sound Medicine’s health policy expert, Aaron Carroll, M.D., M.S., discusses the pros and cons of the upcoming Medicaid expansion. Last June the Supreme Court ruled that state’s participation is Medicaid expansion is optional, but if they choose not to participate they will lose all federal funding for the uninsured. So what does Medicaid expansion entail? According to Dr. Carroll, Medicaid will transition from being a program that covers only poor women, children, the elderly, and disabled, to being a program that covers the majority of people that fall under the poverty line. Most states have decided to accept Medicaid expansion to fund their costs of caring for the poor, but there are a few states that have not decided. Dr. Carroll is an associate professor of pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine. He is also the director of the Center for Health Policy and Professionalism Research.

    Full audio after the jump


    • As you say a surprising turn of events came in Florida where Rick Scot changed his mind, but I believe the legislature will not take the deal. From just the financial side it is difficult to see what will happen, but there are substantial risks. One of Florida state’s largest expenditures is Medicaid and when the government cuts Medicaid reimbursement to the states Florida might be left with multiples in cost that could potentially bankrupt the state (currently Florida is paid less than 60% of Medicaid’s costs).

      One has to recognize that if Florida takes the deal, many of the new enrollees will not qualify for additional state reimbursement because they were previously eligible for Medicaid, but never enrolled. That is a double negative whammy for Florida. Additionally a significant percentage will be dropping private insurance they currently have.

      On the patient side Florida will likely see crowd out because there are not enough physicians to manage all the new enrollees along with all the perks including wellness physicals. We might see the sickest being negatively impacted, while new, very low value care is being offered to about a million and a half new individuals.

    • What exactly does the statement if states “choose not to participate [in the Medicaid expansion], they will lose all federal funding for the uninsured” mean? That those states that don’t accept the expansion will not receive the federal funding for the expansion? That states that don’t do the expansion won’t be able to access federal subsidies for the uninsured who will be coming into the new exchanges? I’m really uncertain about just what that statement is trying to tell the reader. I know that states that don’t opt for expansion are not subject to losing the federal dollars supporting their existing Medicaid program.