On June 29, Families USA released a report examining Medicaid cuts outlined under U.S. Rep. Paul Ryan’s (R-WI) $3.5 trillion FY2012 budget proposal, approved by the U.S. House on April 15.  In addition to repealing most provisions of the national health care reform law, the budget would also convert Medicaid into a block grant program beginning in 2013, reducing state payments by 5 percent in 2013, 15 percent in 2014, and 33 percent in 2021.  Based on an economic modeling tool used by the U.S. Department of Commerce to assess the impact of major events on regional economies, Families USA’s analysis finds that the Medicaid cuts would risk a total of 35,210 jobs and $4.2 billion in economic activity.  The report estimates that the cuts would harm program enrollees, reduce business activity, and contribute to job losses.  The report also provides state-level estimates of the impact of each cut on business activity and jobs.

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The National Governors Association (NGA) and the National Association of State Budget Officers (NABO) released the Spring 2011 Fiscal Survey of States, finding that at least 33 states have plans to reduce Medicaid provider reimbursement rates for the fiscal year beginning July 1.  Facing tough financial climates and the elimination the increased Federal Medical Assistance Percentage (FMAP) funding through the American Recovery and Reinvestment Act (ARRA), on average, governor’s proposed FY2012 budgets include a 2.9 percent reduction in Medicaid funding.  However, states’ share of Medicaid is expected to increase by 18.6 percent as federal funding drops by 13 percent.  In FY2010, Medicaid accounted for an estimated 22 percent of states’ spending.

From the report:

The Urban Institute has released a study finding that states will spend $90 billion from 2014 less under the national health care reform law than they would without it.  The authors attribute those savings to reduced uninsured populations and greater federal financing of services that states previously paid for. 

From the report:

This report finds that state governments are likely to spend $92-129 billion less from 2014 to 2019 with implementation of the Affordable Care Act, thanks to provisions reducing the uninsured population and increasing federal support for health care previously financed by states. The authors find that, overall, the federal government would spend $704 to $743 billion more under reform from 2014 to 2019. Even after 2019, when the federal government's share of Medicaid costs declines to its permanent level, states will still come out ahead, realizing net savings in 2020 alone of $12 to $19 billion.

Full report: State Governments Would Spend at Least $90 Billion Less With the ACA than Without It from 2014 to 2019 (PDF | 459.33 KB)

Urban Institute.  (2011).  State governments would spend at least $90 billion less with the ACA than without it from 2014 to 2019.  Buettgenns, M., Dorn, S. and Carroll, C.

The National Academy for State Health Policy has released a study examining the potential of health information technology (HIT) to improve the Medicaid system in the District of Columbia.  The authors outline investment in HIT infrastructure and project how DC officials may use it to improve quality and oversight in Medicaid.

From the report:

It is widely acknowledged that the lack of information across all levels of our health care delivery structure is a critical factor contributing to current deficits in safety, efficiency, and health outcomes. State Medicaid agencies with responsibility for administering publicly subsidized health coverage - including Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefits for children - face distinct challenges in accessing and using accurate information to monitor the provision of benefits and services provided by the health care system. As has happened in other states, in the District of Columbia (the District) a lawsuit brought these issues to the forefront; the District’s Medicaid agency efforts to ensure the provision of EPSDT benefits are now overseen by the U.S. District Court in the District of Columbia under the terms of the Salazar v. District of Columbia Settlement Agreement. In light of promising developments in the realm of electronic health care information and quality measurement and reporting, the Court requested a report from NASHP to identify and offer recommendations on new and emerging capacity within the District that could enhance oversight of the District’s provision of EPSDT benefits.

Full report: NASHP Report: Health IT, Quality Reporting and Medicaid Well Child Benefits: An Assessment of Progress and Potential in the District of Columbia (PDF | 1.32 MB)

National Academy for State Health Policy.  (2011).  NASHP report: health IT, quality reporting, and Medicaid well child benefits: an assessment of progress and potential in the District of Columbia.  Purington, K., Dierker, L. and Stanek, M.

The Kaiser Family Foundation (KFF) has released a brief examining states’ progress towards implementing the health insurance exchanges required under national health care reform.  The brief examines challenges states face and summarizes early trends in exchange governance, structure, and financing.  The U.S. Department of Health and Human Services (HHS) recently issued regulations giving states until January 1, 2013 to demonstrate their ability to operate a functional exchange.  To date, more than a third of states have begun working towards implementation.  Required in every state by January 1 2014, HHS will operate exchanges in states that are unprepared or unwilling to operate their own.

From the report:

State-based health insurance exchanges are a key component of the Patient Protection and Affordable Care Act (ACA) of 2010, facilitating expanded access to coverage for millions of individuals and employees of small businesses. The health insurance exchanges, scheduled to be operational by January 2014, are intended to enable consumers to readily compare qualified health insurance options in order to select plans that best meet their needs. They will also be the mechanism through which low and moderate-income individuals receive premium and cost-sharing subsidies to make health coverage more affordable. The ACA allows states great latitude in how they design their exchanges, giving them flexibility over such things as how the exchange is structured, how it is governed, and how it certifies and contracts with health plans. If a state chooses not to create its own exchange, the federal government will operate one in the state. By 2019, the Congressional Budget Office estimates that over 24 million people will enroll in a health plan purchased through an exchange.

Full report: Establishing Health Insurance Exchanges: An Update on State Efforts (PDF | 394.49 KB)

Kaiser Family Foundation.  (2011).  Establishing health insurace exchanges: an update on state efforts.  

On July 11, the Robert Wood Johnson Foundation (RWJF) published a brief examining state costs under the national health care reform law.  Citing health reform’s health coverage expansion and increased federal financing for formerly state-funded functions, the authors estimate that, between 2014 and 2019, states will spend up to $129 billion less than they would have without reform.  Over the same period, the brief estimates that the law will reduce overall spending on uncompensated care by 12.5 to 25 percent, saving the federal government $39 billion to $78 billion, while saving states $26 to $52 billion.  The authors estimate that states will be responsible for $14 billion in new Medicaid spending to cover the costs of newly eligible Medicaid enrollees.  The report also projects that expanding Medicaid coverage for individuals with mental illnesses will save states up to $22 billion through 2019. 

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