State Integration for Dual Eligibles
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A not-for-profit health and tax policy research organization /GalenInstitute www.galen.org State Integration for Dual Eligibles Grace-Marie Turner November 30, 2012 Galen Institute
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Transcript of State Integration for Dual Eligibles
A not-for-profit health and tax policy research organization
/GalenInstitutewww.galen.org
State Integration for Dual Eligibles
Grace-Marie TurnerNovember 30, 2012Galen Institute
Source: Jeffrey M. Jones, “Now Against Gov't Healthcare Guarantee,” Gallup Politics, November 28, 2012,http://www.gallup.com/poll/158966/majority-against-gov-healthcare-guarantee.aspx.
Majority of Americans OpposeGovernment Health Care
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2012 2011 2012
64 62 6259
64
58
6964
54
47 47
50
44
3134 35
3934
38
2833
41
50 50
46
54
% Government responsibility % Not government responsibility
Gallup asked: Do you think it is the responsibility of the federal government to make sure all Americans have healthcare coverage,
or is that not the responsibility of the federal government?
Source: Sarah Kliff, “Is ObamaCare too much work for the Obama administration?” The Washington Post, November 12, 2012, http://www.washingtonpost.com/blogs/wonkblog/wp/2012/11/12/is-obamacare-too-much-work-for-the-obama-administration/.
An ObamaCare State Exchange
www.galen.org
Some realities
www.galen.org
Medicaid swamping state budgetsPERCENT OF BUDGET SPENT ON MEDICAID, FY 2008
Source: StateHealthFacts.org
Source: Avik Roy, “How Do Blue States Expand Medicaid? By Paying Doctors Less,” Forbes: The Apothecary, July 23, 2012, http://www.forbes.com/sites/aroy/2012/07/23/how-do-blue-states-expand-medicaid-by-paying-doctors-less/.
Medicaid Dual Eligibles: Enrollment and Spending, FFY 2007
SOURCE: Urban Institute estimates based on data from MSIS and CMS Form 64, prepared for the Kaiser Commission on Medicaid and the Uninsured, 2010.
Total = 58 Million
Medicaid Enrollment
Medicaid Spending
Total = $311 Billion
Duals 15%
Children 50%
Other Aged &
Disabled 10%
Adults 25%
Non-Dual
Spending 60%
Long-Term Care 27%
Prescribed Drugs
0.4%
Premiums 4%
Medicare Acute 6%
Other Acute 2%
Dual Spending
39%
Agreed: We need coordinated care for Duals
• Duals are the most costly of Medicaid patients
• The sickest patients often receive the worst care, with little or no coordination
• Moving Duals into managed care needs to be done carefully to make sure they receive coordinated care and access to needed treatments and medicines
www.galen.org
Analysis of CA Dual-Eligible “pilot”…
• Too many enrollees to be a test project
• Enrollment process doesn’t protect beneficiaries
• Lower-quality plans selected for price; little experience in complex care delivery.
• Losing access to regular physicians, exacerbating continuity of care problems
Letter to Melanie Bella, Director, Medicare-Medicaid Coordination Office, June 29, 2012. National Senior Citizens Law Center, www.nsclc.org.
Prescription Drug Coverage Among Medicare Beneficiaries, 2010
NOTES: Numbers do not sum to 100 percent due to rounding. 1Includes Veterans Affairs, retiree coverage without RDS, Indian Health Service, state pharmacy assistance programs, employer plans for active workers, Medigap, multiple sources, and other sources. 2Includes Retiree Drug Subsidy (RDS) and FEHBP and TRICARE retiree coverage. SOURCE: Centers for Medicare & Medicaid Services, 2010 Enrollment Information (as of February 16, 2010).
Total Number of Medicare Beneficiaries = 46.5 Million
Total in
Part D Plans: 27.7
Million(60%)
Stand-Alone
Prescription Drug
Plan (PDP)
Medicare Advantage Drug
Plan
Retiree Drug Coverage2
No Drug Coverage
Other Drug Coverage1
4.7millio
n10%
9.9 millio
n21%
8.3 millio
n18%
5.9millio
n13%
17.7millio
n38%
Medicare Beneficiaries Eligible for Low-Income Subsidies, 2009 = 12.5 million
Applied for and receiving subsidy
Eligibility and Participation in Medicare Part D
Low-Income Subsidies, 2009
Eligible but estimated to have other drug coverage
0.5 million (4%)1
1.5 million 12%
NOTES: 1Includes Veterans Affairs, Indian Health Service, and Retiree Drug Subsidy (RDS) coverage. 2MSP is Medicare Savings Program; SSI is Supplemental Security Income. SOURCE: Centers for Medicare and Medicaid Services, 2009 Enrollment Information (as of February 1, 2009)
Eligible but not receiving subsidy
2.3 million 19%
Full dual eligibles automatically
receiving subsidy
6.3 million 50%
Future anticipated facilitated enrollment = <0.1 million
(0.1%)
MSP and SSI recipients automatically receiving subsidy2
1.8 million 15%
Defined contribution – template for reform
• Long-term Medicare – and Medicaid – reform relies on giving people choices of private competing plans
• Medicare Part D is a prime example of how to increase choice and save money for taxpayers and seniors – Spending is 46% less than projected!
• Undermining the Part D competitive model is bad for seniors in restricting access to drugs and for our future prospects for entitlement reform.
www.galen.org
Why ObamaCare Is Wrong for America
How does the health care law drive up costs?
Is your doctor really in charge of your health care decisions?
Are your Constitutional rights threatened?
Discover the law’s impact on your life in a new book from four nationally recognized health policy experts
Published by Broadside Books, an imprint of HarperCollins
www.WrongForAmericaBook.com
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A not-for-profit health and tax policy research organization
/GalenInstitutewww.galen.org
Grace-Marie Turner
Galen Institute
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