The Impact of Medicaid Expansion on Uncompensated Care Costs: Early Results and Policy Implications for States
Deborah Bachrach, Patricia Boozang, and Mindy Lipson, Manatt Health Solutions
Since implementation of the Affordable Care Act (ACA), the 30 states that have expanded Medicaid have enrolled more than 10 million people in Medicaid or the Children’s Health Insurance Program and the collective rate of uninsured individuals in these states has fallen from 18 percent to less than 11 percent. Recent research by Manatt Health Solutions looked at the fiscal implications of expansion and found that, in addition to coverage gains, expansion states experienced significant budget savings and revenue gains. This issue brief, the third in this series prepared by Manatt Health Solutions, examines early data on expansion-related decreases in uncompensated care costs and related state budget implications. It also looks at impending reductions in federal support for Medicaid Disproportionate Share (DSH) payments and waiver pools made available to support hospital uncompensated care costs prior to the Medicaid expansion authorized and funded under the ACA.
As the United States enters its seventh month of the COVID-19 vaccine rollout, available data show distribution efforts have not produced equitable outcomes. This expert perspective details how state leaders can use administrative, policy, and funding levers to support community partners in improving access points, addressing structural barriers to vaccination, and establishing rapid data collection and evaluation efforts for equitable COVID-19 vaccine distribution solutions.
With the passage of the American Rescue Plan (ARP), more people than ever before are eligible for financial help to pay for a health insurance plan. Estimates are that on average, 4 out of 5 customers can now find a health plan for less than $10 a month—a remarkable step to provide more affordable coverage, for more Americans. To promote these significant savings, Marketplaces are launching integrated and innovative outreach campaigns—including tapping into existing public health and COVID-19 vaccination efforts—to reach residents with this important information and get them enrolled. As vaccine distribution is increasingly going local, state marketplaces are tapping into trusted partners like local community centers, faith groups, and small businesses as well as coordinating with state and federal agencies to combine education and outreach to drive enrollment. As Marketplaces look for ways to ensure equitable outreach and enrollment, especially as our nation recovers from COVID-19, this expert perspective highlights a range of communications and outreach strategies to align with vaccine education and distribution.
The rollout of vaccines designed to end the coronavirus (COVID-19) crisis has begun in earnest across the United States. Currently, each state is responsible for determining how to allocate, distribute, track, and report its vaccine allotment from the federal government, although the federal government is expected to take on a larger role under a new Biden administration. Since the beginning of the pandemic, Black, Indigenous, and other people of color have been disproportionately impacted by both higher risks of infection and poorer health outcomes, and many are concerned that an inequitable or inefficient distribution of the COVID-19 vaccine may further widen health inequities among these populations. One way to help ensure the equitable administration of COVID-19 vaccine is to track vaccine administration disaggregated for key subpopulations, such as gender, race and ethnicity, and geography (e.g., urban vs. rural). This expert perspective reviews the data states are currently publicly reporting related to vaccine administration and provides an interactive map that explores the extent to which all 50 states are reporting vaccine administration data breakdowns by age, gender, race, ethnicity, provider type, and level of geography. The expert perspective also discusses what current data sources states are using to provide this information and provides an overview of options states can consider to collect information about the administration of COVID-19 vaccine in populations via survey data.