So much of the focus when it’s come to the Affordable Care Act has been about how many have enrolled, and which states will expand Medicaid. I worked to go deeper to tell the untold stories about the unexpected consequences and benefits of the Health Policy law. Key findings: 1. Obamacare enrollees are straining the finances of community health centers around the country. The issue is that many lower-income patients with insurance coverage through the federal and state exchanges bought bronze-tier plans with lower premiums but high deductibles, coinsurance and copayments and no federal cost-sharing subsidies. When these patients face high out-of-pocket costs for care that falls below the deductible, they can’t afford it. So the centers are subsidizing that care by offering them means-tested sliding-scale fees. When the centers, which are not allowed to turn away patients for inability to pay, try to get the insurers to pay, the claims are usually denied, and the centers have to write it off as uncompensated care. 2. A provision of the ACA allowed the CMS to create an initiative to coordinate the care of people dually eligible for Medicare and Medicaid. Just over 9 million dual-eligibles account for 40% of all Medicaid spending and 27% of all Medicare spending, with their care costs totaling about $350 billion a year. Under this initiative, California, Illinois, Massachusetts, Ohio, and Virginia have opted to launch coordinated-care demonstrations. Demonstrations also are slated to begin in the coming months in Michigan, New York, South Carolina, Texas, and Washington. In November, the CMS uncovered evidence that some healthcare providers are illegitimately trying to dissuade dual-eligible beneficiaries from participating in the dual demonstrations. One reason for this is that the doctors preferred the fee for service model they are used to treating duals, vs the capitated model the duals demonstration operates under. 3. The number of Americans applying for Supplemental Security Income benefits dropped in the first six months in 2014 compared to the same period last year, and it’s possible that the decline is partly related to the healthcare reform law’s Medicaid expansion to low-income adults. The possible link is that before the ACA qualifying for SSI benefits automatically made a person eligible for Medicaid in 39 states. It’s thought that one major reason people apply for SSI is to receive Medicaid coverage. But with the Medicaid expansion to low-income adults this year under the Patient Protection and Affordable Care Act, people in expansion states no longer have to apply for SSI to get Medicaid. 4. Many states are struggling to re-enroll adults and children in Medicaid and the Children’s Health Insurance Program, with hundreds of thousands of current beneficiaries at risk of losing coverage, advocates say. The enrollees who are at greatest risk are those who were enrolled in Medicaid prior to the Patient Protection and Affordable Care Act and the establishment of a new formula to define household income under the Modified Adjusted Gross Income (MAGI) standard. The problem in re-enrolling such beneficiaries is that these pre-ACA enrollees do not necessarily understand their states’ requests for additional information, which is needed to determine if they are still eligible for Medicaid under the new MAGI standard.
