Medicaid Opportunities & Challenges Task Force June 25, 2013 Jeff Bechtel, Senior Consultant

1. Update of Research Findings: Economic, Health and Personal Financial Impacts of Medicaid Expansion Medicaid Opportunities & Challenges Task Force June 25, 2013 Jeff Bechtel, Senior Consultant

2. Summary of Last Meeting • Reviewed summary of findings (e.g. mortality, access to care, recent Oregon study) • Asked to “double check” findings • Requested feedback, suggestions

3. Today’s Presentation • Research – Opposing Views • “Deeper Dive” into Oregon Findings

4. The Case Against Medicaid • Performed research relating to quality and access in the Medicaid Program • Reviewed reports, data prepared by organizations and think tanks opposed to Medicaid expansion (e.g. Heritage Foundation, Cato Institute) • Summarized findings from recent document issued by Heritage Foundation • Kevin Dayaratna, “Studies Show Medicaid Patients Have Worse Access and Outcomes than the Privately Insured,” Heritage Foundation Backgrounder No. 2740, November 7, 2012, http://www.heritage.org/research/reports/2012/11/studies-show-medicaid-patients-have-worse-access-and-outcomes-than-theprivately-insured

5. Report Summary • Adequate access to care is a problem for children on Medicaid: • 2001 Study – Children with Asthma on Medicaid receive less effective care than Children with Asthma on private insurance • 2004 Study – Specialty Surgeons in California less likely to accept children enrolled in Medicaid, compared to private insurance • 2005 Study – Urologic offices less likely to accept children enrolled in Medicaid, compared to private insurance • 2006 Study – Disparity between access to specialty care for privately insured children in Cook County Illinois compared to privately insured individuals

6. Report Summary (cont’d) • There are health disparities between adult Medicaid recipients and individuals who are privately insured. • Medicaid recipients have significantly more difficulty accessing specialty care than privately insured patients. • Nearly one-third of physicians nationwide will not accept new Medicaid patients.

7. Observations • Medicaid Programs and reimbursement rates vary by state – difficult to generalize from state to state. • Comparisons are between Medicaid and private insurance, not Medicaid and no insurance at all. • There are competing studies relating to Medicaid access to care, demonstrating that access for individuals on Medicaid and private insurance are roughly equivalent: • Kaiser Report: http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8000-02.pdf • MACPAC Report: https://docs.google.com/viewer?a=v&pid=sites&srcid=bWFjcGFjLmdvdnxtYWNwYWN8Z3g6MzM2ZWM3ZjlhMDI1ZGFhNw • Discussion

8. Follow-up:Mortality Study • During the last meeting, we reviewed a NEJM study that found that Medicaid coverage is Associated with Lower Rates of Death. See: Benjamin D. Sommers, M.D., Ph.D. et al., Mortality and Access to Care Among Adults After Medicaid Expansions, NEJM. (July 25, 2012). • Study Summary: • Reviewed 3 states with waivers to cover low-income adults: Arizona, Maine and New York. • Findings - Compared to neighbor states, adults with Medicaid experienced: • Reduction in mortality (-6.1% or 19.6 deaths/ 1,000) • Less delayed care due to cost (-21%)

9. Follow-up – Mortality Study (cont’d) • Study observations – Michael Cannon, CATO Institute • Study comes with caveats: the results “may not be generalizable to other states,” may have been driven by unobservable confounding factors. • Program spends nearly half a trillion dollars per year. • Other strategies could save more lives per dollar spent than expanding health insurance. • Source: http://www.cato.org/blog/460-billion-year-medicaid-darn-well-better-save-lives

10. Oregon Study Observations • Discussed findings during last meeting. • Additional study observations from commentators: • Preventive care isn’t always effective. • Quality in health care is a problem; a focus should be placed on paying for outcomes. This problem isn’t unique to Medicaid. • Healthcare coverage doesn’t automatically eliminate factors like lack of education, lack of access to healthy food and household financial strain that can impact health and health management. • Insurance is about health, but it’s also about money. • The study didn't measure overall health status and the effects over time. Rather, it included only a few measures, such as blood pressure, cholesterol and blood sugar levels, over only two years. • Additional, and more conclusive, information will be available over time.

11. Discussion

12. Questions? Sellers Dorsey sellersdorsey.com Jeff Bechtel Senior Consultant Sellers Dorsey 717.695.4342 jbechtel@sellersdorsey.com