The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States

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The dashboard captures the access, quality and cost of care; overall population health; and health system dynamics e. Waiting times in American health care are usually short, but are not usually 0 for non-urgent care at least. Also, a minority of American patients wait longer than is perceived.

Health care in the United States

In a Commonwealth Fund survey, most Americans self-reported waiting less than four weeks for their most recent specialist appointment and less than one month for elective surgery. The number of respondents may not be enough to be fully representative. In a study in comparing Ontario to three regions of the U. Mean waits for the knee or hip surgery were self-reported as three weeks in those parts of the U. However, current waits in both countries' regions may have changed since then certainly in Canada waiting times went up later.

This appears to be short compared with Canada's waiting time, but may compare less favorably to countries like Germany, the Netherlands where the goal was 5 weeks , and Switzerland.

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It is unclear how many of the patients waiting longer have to. Some may be by choice, because they wish to go to a well-known specialist or clinic that many people wish to attend, and are willing to wait to do so. Waiting times may also vary by region. One experiment reported that uninsured patients experienced longer waits; [ citation needed ] patients with poor insurance coverage probably face a disproportionate number of long waits. American health care tends to rely on rationing by exclusion uninsured and underinsured , out-of-pocket costs for the insured, fixed payments per case to hospitals resulting in very short stays , and contracts that manage demand instead.

The health of the population is also viewed as a measure of the overall effectiveness of the healthcare system.

How a state’s choice on Medicaid expansion affects hospitals

The extent to which the population lives longer healthier lives signals an effective system. This aspect of the healthcare system performance dashboard is important to consider when evaluating cost of care in America. That is because in much of the policy debate around the high cost of US healthcare, proponents of highly specialized and cutting edge technologies point to innovation as a marker of an effective health care system.

The study found that the United States failed to achieve better outcomes than other countries, and is last or near last in terms of access, efficiency and equity. Study date came from international surveys of patients and primary care physicians , as well as information on health care outcomes from The Commonwealth Fund, the World Health Organization , and the Organisation for Economic Co-operation and Development.

As of , the U. A study found that between and , preventable deaths declined more slowly in the United States than in 18 other industrialized nations. Among OECD nations for which data are available, the United States ranked third last for the health care of women after Mexico and Hungary and fifth last for men Slovakia and Poland also ranked worse. Recent studies find growing gaps in life expectancy based on income and geography. In , a government-sponsored study found that life expectancy declined from to for women in counties, and for men in 11 counties, with most of the life expectancy declines occurring in the Deep South, Appalachia, along the Mississippi River, in the Southern Plains and in Texas.

The difference is as high as three years for men, six years for women. The gap is growing between rich and poor and by educational level, but narrowing between men and women and by race. National Research Council forecasted that deaths attributed to smoking, on the decline in the US, will drop dramatically, improving life expectancy; it also suggested that one-fifth to one-third of the life expectancy difference can be attributed to obesity which is the worst in the world and has been increasing.

The debate about U. A report released in April by the Foundation for Child Development , which studied the period from through , found mixed results for the health of children in the U. The percentage of mothers who smoked during pregnancy also declined. On the other hand, both obesity and the percentage of low-birth weight babies increased. The authors note that the increase in babies born with low birth weights can be attributed to women delaying childbearing and the increased use of fertility drugs.

In a sample of 13 developed countries the US was third in its population weighted usage of medication in 14 classes in both and The study noted considerable difficulties in cross border comparison of medication use. A critic of the U. Variations in the efficiency of health care delivery can cause variations in outcomes. The Dartmouth Atlas Project , for instance, reported that, for over 20 years, marked variations in how medical resources are distributed and used in the United States were accompanied by marked variations in outcomes. The Affordable Care Act, if implemented, will produce an additional demand for services which the existing stable of primary care doctors will be unable to fill, particularly in economically depressed areas.

Training additional physicians would require some years. Lean manufacturing techniques such as value stream mapping can help identify and subsequently mitigate waste associated with costs of healthcare. In , coronary artery disease , lung cancer , stroke , chronic obstructive pulmonary diseases , and traffic accidents caused the most years of life lost in the US.

Low back pain, depression , musculoskeletal disorders , neck pain, and anxiety caused the most years lost to disability. The most deleterious risk factors were poor diet, tobacco smoking, obesity, high blood pressure , high blood sugar , physical inactivity, and alcohol use. Alzheimer's disease , drug abuse, kidney disease and cancer, and falls caused the most additional years of life lost over their age-adjusted per-capita rates.

Between and , among the 34 countries in the OECD, the US dropped from 18th to 27th in age-standardized death rate. The US dropped from 23rd to 28th for age-standardized years of life lost. It dropped from 20th to 27th in life expectancy at birth. It dropped from 14th to 26th for healthy life expectancy. According to a study conducted at Harvard Medical School by co-founders of Physicians for a National Health Program , a pro-single payer lobbying group, and published by the American Journal of Public Health , lack of health coverage is associated with nearly 45, excess preventable deaths annually.

Goodman for not looking at cause of death or tracking insurance status changes over time, including the time of death. A study by former Clinton policy adviser Richard Kronick published in the journal Health Services Research found no increased mortality from being uninsured after certain risk factors were controlled for. A study of international health care spending levels published in the health policy journal Health Affairs in the year found that the United States spends substantially more on health care than any other country in the Organisation for Economic Co-operation and Development OECD , and that the use of health care services in the U.

The authors of the study conclude that the prices paid for health care services are much higher in the U. Uninsured Americans are less likely to have regular health care and use preventive services. They are more likely to delay seeking care, resulting in more medical crises, which are more expensive than ongoing treatment for such conditions as diabetes and high blood pressure. A study published in JAMA concluded that uninsured people were less likely than the insured to receive any medical care after an accidental injury or the onset of a new chronic condition.

The uninsured with an injury were also twice as likely as those with insurance to have received none of the recommended follow-up care, and a similar pattern held for those with a new chronic condition. In researchers with the American Cancer Society found that individuals who lacked private insurance including those covered by Medicaid were more likely to be diagnosed with late-stage cancer than those who had such insurance. The treatment given to a patient can vary significantly depending on which health care providers they use. Research suggests that some cost-effective treatments are not used as often as they should be, while overutilization occurs with other health care services.

Unnecessary treatments increase costs and can cause patients unnecessary anxiety. The way the Health care system tries to eliminate this problem is through cost sharing tactics like co-pays and deductibles. If patients face more of the economic burden they will then only consume health care when they perceive it to be necessary.

According to the RAND health insurance experiment, individuals with higher Coinsurance rates consumed less health care than those with lower rates. The experiment concluded that with less consumption of care there was generally no loss in societal welfare but, for the poorer and sicker groups of people there were definitely negative effects. These patients were forced to forgo necessary preventative care measures in order to save money leading to late diagnosis of easily treated diseases and more expensive procedures later.

With less preventative care, the patient is hurt financially with an increase in expensive visits to the ER. The health care costs in the US will also rise with these procedures as well. More expensive procedures lead to greater costs. One study has found significant geographic variations in Medicare spending for patients in the last two years of life. These spending levels are associated with the amount of hospital capacity available in each area. Higher spending did not result in patients living longer. Primary care doctors are often the point of entry for most patients needing care, but in the fragmented health care system of the U.

For example, a Harris Interactive survey of California physicians found that:. According to an article in The New York Times , the relationship between doctors and patients is deteriorating. Doctors may focus on diagnosis and treatment, while patients may be more interested in wellness and being listened to by their doctors.

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  7. Many primary care physicians no longer see their patients while they are in the hospital; instead, hospitalists are used. The largest increases in administrative costs were in customer service and information technology, and the largest decreases were in provider services and contracting and in general administration. Variations in administrative costs between private plans are largely attributable to economies of scale.

    Coverage for large employers has the lowest administrative costs. The percentage of premium attributable to administration increases for smaller firms, and is highest for individually purchased coverage. Most Americans pay for medical services largely through insurance, and this can distort the incentives of consumers since the consumer pays only a portion of the ultimate cost directly.

    Enrollment rules in private and governmental programs result in millions of Americans going without health care coverage, including children. Medicaid, which is available for those under certain income levels, does not guarantee access as physicians may elect to not accept Medicaid patients due to slow reimbursement, complex regulations, too much paperwork, and the necessity for extra staff to process the excess paperwork. The lack of coverage results in death due to lack of needed care [].

    Mental illness affects one out of six adults in the United States. That is about A report by the U. The Paul Wellstone Mental Health and Addiction Equity Act of mandates that group health plans provide mental health and substance-related disorder benefits that are at least equivalent to benefits offered for medical and surgical procedures.

    The legislation renews and expands provisions of the Mental Health Parity Act of The law requires financial equity for annual and lifetime mental health benefits, and compels parity in treatment limits and expands all equity provisions to addiction services. Insurance companies and third-party disability administrators most notably, Sedgwick CMS used loopholes and, though providing financial equity, they often worked around the law by applying unequal co-payments or setting limits on the number of days spent in inpatient or outpatient treatment facilities.

    Medicaid - Wikipedia

    Prior to the Patient Protection and Affordable Care Act , medical underwriting was common, but after the law came into effect in it became effectively prohibited. Health disparities are well documented in the U. The average senior fills 38 prescriptions annually. There is considerable research into inequalities in health care. In some cases these inequalities are caused by income disparities that result in lack of health insurance and other barriers to receiving services.

    In other cases, inequalities in health care reflect a systemic bias in the way medical procedures and treatments are prescribed for different ethnic groups. Raj Bhopal writes that the history of racism in science and medicine shows that people and institutions behave according to the ethos of their times. The consistent and repeated findings were that black Americans received less health care than white Americans — particularly when the care involved expensive new technology.

    The Food and Drug Administration FDA [] is the primary institution tasked with the safety and effectiveness of human and veterinary drugs. It also is responsible for making sure drug information is accurately and informatively presented to the public. The FDA reviews and approves products and establishes drug labeling , drug standards, and medical device manufacturing standards.

    It sets performance standards for radiation and ultrasonic equipment. One of the more contentious issues related to drug safety is immunity from prosecution. In , the FDA reversed a federal policy, arguing that FDA premarket approval overrides most claims for damages under state law for medical devices. In this was confirmed by the Supreme Court in Riegel v. On June 30, , an FDA ruling went into effect extending protection from lawsuits to pharmaceutical manufacturers, even if it was found that they submitted fraudulent clinical trial data to the FDA in their quest for approval.

    This left consumers who experience serious health consequences from drug use with little recourse. On March 4, , an important U. Supreme Court decision was handed down. In Wyeth v. Levine , the court asserted that state-level rights of action could not be pre-empted by federal immunity and could provide "appropriate relief for injured consumers. During the s, the price of prescription drugs became a major issue in American politics as the prices of many new drugs increased exponentially, and many citizens discovered that neither the government nor their insurer would cover the cost of such drugs.

    Per capita, the U. Such governments should either deregulate their markets, or raise their domestic taxes in order to fairly compensate U. In turn, pharmaceutical companies would be able to continue to produce innovative pharmaceuticals while lowering prices for U. Currently, the U. Democrats have charged that the purpose of this provision is merely to allow the pharmaceutical industry to profiteer off of the Medicare program. In , the American Medical Association called for the banning of direct-to-consumer advertising because it is linked with increased drug prices. When health care legislation was being written in , the drug companies were asked to support the legislation in return for not allowing importation of drugs from foreign countries.

    In , prior to the major healthcare reform in , Americans were divided in their views of the U. Much of the historical debate around healthcare reform centered around single-payer health care , and particularly pointing to the hidden costs of treating the uninsured [] while free-market advocates point to freedom of choice in purchasing health insurance [] [] [] and unintended consequences of government intervention, citing the Health Maintenance Organization Act of The costs of these provisions are offset by a variety of taxes, fees, and cost-saving measures, such as new Medicare taxes for high-income brackets , taxes on indoor tanning , cuts to the Medicare Advantage program in favor of traditional Medicare, and fees on medical devices and pharmaceutical companies; [] there is also a tax penalty for citizens who do not obtain health insurance unless they are exempt due to low income or other reasons.

    The first open enrollment period of the Affordable Care Act began in October Prior to this period, access to healthcare and insurance coverage trends were worsening on a national level. A large, national survey of American adults found that after the act's first two enrollment periods, self-reported coverage, health, and access to care improved significantly. Furthermore, insurance coverage for low-income adults were significantly greater in states that expanded Medicaid in comparison with states that did not expand Medicaid.

    Those insured by Medicaid tend to report fair or poor health, as opposed to excellent or very good health. In May , the state of Vermont became the first state to pass legislation establishing a single-payer health care system. The legislation, known as Act 48, establishes health care in the state as a "human right" and lays the responsibility on the state to provide a health care system which best meets the needs of the citizens of Vermont. After reviewing the costs and procedures for implementing such a program, the state decided against such a measure in late Inside the final version of the bill was a repeal of the individual mandate in the Affordable Care Act, which required individuals and companies to get healthcare for themselves and their employees.

    It was this mandate which kept healthcare costs down under the PPACA by promoting cost sharing over a larger pool. Economists believe the repeal of the individual mandate will lead to higher premiums and lower enrollment in the current market though they do not agree with how much. Although the Affordable Care Act and the American Health Care Act both propose tax cuts in order to make insurance more affordable for Americans; however, each of these bills affected Americans in different ways.

    The people most affected by President Trump's plan are young people, individuals of a higher socioeconomic status, and people who live in urban areas. Young people because individuals between the age of 20 and 30 will see drops in the premiums they pay within their plans. In addition, those in urban areas can also benefit from the plan because under Obamacare tax credits were designated also by the cost of local healthcare, but the American Health Care Act does not take this into consideration although rural healthcare is generally more expensive due to the lack of hospitals and available services.

    Of the In , Among those immigrants who became citizens, In each age and income group, immigrants are less likely to have health insurance. Undocumented immigrants within the United States do not have access to government funded health insurance. Although The Affordable Care Act allows immigrants to receive insurance at a discounted rate, the same does not go for those without US citizenship. From Wikipedia, the free encyclopedia.

    This article needs to be updated. Please update this article to reflect recent events or newly available information. March Obama administration proposals Public opinion Reform advocacy groups Rationing Insurance coverage. Free market Health insurance exchange Nationalized insurance Publicly-funded Single-payer Canadian vs. American Two-tier Universal. Third-party payment models. All-payer rate setting Capitation Fee-for-service Global payment. This section is empty. You can help by adding to it. December See also: List of causes of death by rate.

    Main article: Physician in the United States. This section is written like a personal reflection, personal essay, or argumentative essay that states a Wikipedia editor's personal feelings or presents an original argument about a topic. Please help improve it by rewriting it in an encyclopedic style. April Learn how and when to remove this template message. See also: Hospital Quality Incentive Demonstration.

    Further information: Comparison of the healthcare systems in Canada and the United States. Main article: Health insurance coverage in the United States.

    Health benefits of expansion

    Main article: Race and health in the United States. See also: Regulation of therapeutic goods in the United States. This article appears to contradict the article Prescription drug prices in the United States. Please see discussion on the linked talk page. October Learn how and when to remove this template message. Main article: Prescription drug prices in the United States. Further information: Health care reform in the United States. Main article: Immigrant health care in the United States.

    New York Times. Retrieved December 22, Retrieved December 1, American Journal of Public Health. Taxpayers Money? Retrieved July 12, May 25, Retrieved May 26, The World Factbook. Retrieved April 22, July 10, Journal of the American Medical Association. Retrieved July 11, Retrieved February 28, Woolf and Laudan Aron, Eds. Healthcare: Most Expensive and Worst Performing". The Atlantic. June 16, June 22, Harvard Gazette.

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    September 17, June 25, Overview of Hospital Stays in the United States, November Health Serv Res. Committee on the Consequences of Uninsurance January 13, Insuring America's health: principles and recommendations. Archived from the original on October 19, Millman M, editor. Washington: National Academies Press; Retrieved November 25, Towards high-performing health systems: policy studies. The OECD health project. Paris: OECD. Washington, DC: U.

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    Government Printing Office. The Wall Street Journal. Retrieved November 21, Wolf, Richard September 17, USA Today. September 16, Washington, D. Census Bureau. Roberts, Michelle; Rhoades, Jeffrey A. August 19, Rockville, Md. Cohen, Robin A. September 22, Hyattsville, Md. Minneapolis, Minn. August 26, Health Affairs. The New England Journal of Medicine. Journal of Health Economics. American Journal of Health Economics.

    June 5, Retrieved June 22, Journal of General Internal Medicine. American College of Physicians. Archived from the original PDF on July 7, Retrieved October 22, Suppl Web Exclusives: W5——W5— World Health Organization. Retrieved September 5, Retrieved September 9, The World Bank. Retrieved February 17, Retrieved May 5, August 3, Hospitals, AHA".

    American Hospital Association. Archived from the original PDF on February 26, Archived from the original on November 3, Retrieved May 17, Healthcare Dive. Health Care Delivery Systems". September 20, Retrieved May 22, The Agenda. Retrieved May 24, September 1, The American Journal of the Medical Sciences. Snyder Journal of Medical Regulation. Archived from the original PDF on December 15, Retrieved December 20, Archived from the original PDF on October 4, Archived from the original on August 23, Retrieved November 6, Archived from the original PDF on December 30, Retrieved June 20, Chemistry and Industry.

    Washington Post. Retrieved January 18, November 18, American Journal of Medical Research. June 14, July 25, National Health Statistics Reports 12 : 1— Ann Intern Med. Free full-text. Lay summary — WBUR. World health statistics Geneva: World Health Organization. Retrieved February 27, The Henry J. Kaiser Family Foundation. October 3, International Journal of Health Services. Some of the impacts from the Affordable Care Act have also led some insurers to invest in scale. For instance, four major payers - Humana, Aetna, Anthem, and Cigna - are forming two mergers in order to stabilize costs of operating health coverage in the ever-changing healthcare landscape.

    However, health insurance mergers and acquisitions may also play a role in increasing the costs of premiums. While payers claim that premiums will decrease due to mergers, the opposite may actually be true, stated the Harvard Business Review. When there is more competition in the market, there is actually a greater downward shift in medical costs. Whether or not payers decide to invest in mergers and acquisitions , it is clear that the Affordable Care Act has produced a significant impact on the expenses of health insurance companies.

    Premium costs and other insurance rates are going up significantly among plans being sold on the health insurance exchanges, said Joel White, President of the Council for Affordable Health Coverage. Last year, we had an average premium increase of We saw about a 20 percent increase in deductibles on the Silver Plans. Generally, across all plans, premiums were up as well as deductibles and cost-sharing were up in the double digit range.

    In some cases, they have shown more than 20 percent increases of premium rate filing. White also found that premium rates are ever-increasing around the nation ever since the Affordable Care Act took effect three years ago. While there has been a decline of premium prices within seven states, there were also double-digit rises in a total of 21 states, according to a report from The Commonwealth Fund.

    Risk pool adjustments are not great and there is about half the projected enrollment. Originally, it was expected that there would be 21 million in the risk pool. Additionally, the individual mandate has required the majority of Americans to enroll in health plans or else risk a tax penalty. Taxpayers will pick up the bill for those cost increases. They get shifted onto taxpayers and taxpayers then pay the costs of those subsidies. A better strategy is not cost-shifting. Cost reduction is a good cost containment strategy. Along with the higher premium costs found among health plans sold on the exchanges, more payers have invested in implementing high-deductible health plans.

    Lots of different factors are going on. The biggest regulatory change that has dramatically transformed the health insurance industry is the individual mandate. The individual mandate requires every American to have health insurance or else face a tax penalty. This has led health payers to cover many more individuals and families than ever before, which is a major impact on the insurance industry and its revenue stream. Because payers no longer have the opportunity to serve the only the healthiest and least expensive consumers, the industry is starting to focus its efforts on pay-for-performance reimbursement models.

    Most Medicaid beneficiaries are enrolled in managed care plans. It also changes the game for health insurers when there are fewer gaps in coverage and when there is payment for care that is provided, insurers can increasingly focus on how to improve quality and value and move to new kinds of delivery systems and payment arrangements which all depend on in large ways people having payment for services. Essentially, Mann explained that, when payment for healthcare is assured and gaps are closed, providers and payers can focus their efforts on improving the quality of services, patient outcomes, and moving toward alternative payment models by embracing value-based care reimbursement.

    On the other side of the equation, when the Affordable Care Act implemented the individual mandate and eliminated pre-existing condition clauses, the risk pool health payers manage changed drastically and led many health insurance companies to lose money selling plans on the exchanges. Now that payers are incentivized to change their reimbursement strategies and push for more efficient preventative care, there is more focus on consumer engagement, says Jose Vazquez, Vice President of Solutions at the University of Maryland Medical System.

    While the individual mandate of the Affordable Care Act is meant to bring healthcare coverage to as many eligible Americans as possible, there are still some regulatory hurdles standing in the way for many potential consumers. In , the Supreme Court passed a ruling stating that state Medicaid expansion would be optional under the Affordable Care Act.

    At this point in time, 19 states have still not expanded their Medicaid program despite the fact that the federal government would cover more than 90 percent of the costs associated with this expansion. When comparing the populations in states that have not expanded Medicaid to the 31 states that took part in Medicaid expansion, there is a significant difference in healthcare access and the drop in uninsured rate.

    Then the Supreme Court decision came down in and made it voluntary with states. Only certain pockets of poor people had coverage. There is still a coverage gap found in states without Medicaid expansion and patients still face the same barriers to primary care access that made care delivery difficult before the ACA, said Mann. Source: Henry J. The ACA has also brought provisions that require health payers to fully cover preventive services such as immunizations and cancer screenings.

    This completely eliminates out-of-pocket expenses for consumers who are seeking preventive care and provides a clear incentive for patients to pursue preventive medicine. The availability of primary and preventive care without cost really opens up services to people that otherwise were price sensitive and were discouraged from accessing. In general, federal legislation such as the prior meaningful use requirements have brought a greater focus on reforming the healthcare industry into a system that incentivizes quality over quantity.

    This has included the incorporation of new technologies such as electronic health records and data analytics software as well as general strategies to improve care coordination and implement new models of healthcare delivery. These include accountable care organizations ACOs. ACOs are founded on the idea that care coordination between specialists, primary care doctors, hospitals, and health payers will help to boost quality by preventing patients from falling through communication gaps along the care continuum. Consumer engagement and consumer choice is becoming more prevalent among health plans as well as the entirety of the care delivery continuum.

    With some payers losing revenue in the new healthcare landscape, the clear choice is to embrace consumer engagement and preventive medicine in order to create a healthier population while reducing spending. Accountable care organizations are being adopted to achieve these goals. A lot of the ACO activity is in formation.

    The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States
    The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States
    The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States
    The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States
    The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States
    The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States
    The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States
    The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States The New Health Care Laws Effect on State Medicaid Spending: A Study of the Five Most Populous States

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