Explainer: How the Election Outcome Could Affect Medicaid
Medicaid is the largest public insurer in the United States, providing health care access to more than 81 million people with low income. The program covers 42 percent of all births in the country, and it’s the primary payer for behavioral health and long-term care services. In the latest explainer in our What’s at Stake in the 2024 Election series, we look at how the outcome of the 2024 election could shape Medicaid in the coming years. Learn how each candidate might approach Medicaid coverage, access to care, affordability, and health disparities.
Low Enrollment in Georgia’s Medicaid Work Requirement Initiative
Instead of expanding Medicaid eligibility as most other states have done, Georgia pursued a federal waiver to launch its “Pathways” program, which includes a mandate that Medicaid enrollees work or participate in job training to be able to enroll. But enrollment in Pathways is far lower than predicted, write MaryBeth Musumeci and colleagues on To the Point. Georgia estimated that 100,000 people would enroll in the first year, but recent data show only 2,344 active enrollees. Despite low enrollment, the program has cost the state at least $26 million.
The Affordable Care Act has provided tens of millions of Americans with access to comprehensive, low-cost health coverage and free preventive services, while allowing people with preexisting health conditions to buy coverage on their own. But the law potentially faces political headwinds: Donald Trump and a number of Republicans in Congress have long called for its repeal. In a new explainer, health economist John Holahan shows how overturning the ACA would affect health insurance coverage; what would happen to people with lower incomes, who have benefited most from the law; and what the impact would be on health care providers and their finances.
What percentage of Medicare beneficiaries are considered underinsured?
5 percent
8 percent
14 percent
19 percent
Scroll down to see if you got it right.
Webinar: Women’s Health Policies, State by State
Women’s health care in the U.S. faces critical challenges. Across the country, there are significant disparities in access to quality health care across geographic, racial, ethnic, and economic lines. Join the Commonwealth Fund and leading experts on Wednesday, September 18, from 12:00 to 1:00 pm ET for a webinar exploring the implications of new state-level data from the 2024 State Scorecard on Women’s Health and Reproductive Care. The conversation will delve into challenges and opportunities ahead for policymakers working to ensure that women — no matter where they live — have access to comprehensive health and reproductive care.
Patients in Abortion-Ban States Face New Challenges
In areas of the U.S. where no maternity care is readily available, community health centers may be the only options for comprehensive women’s health care. But in states with abortion bans, many health center patients face challenges getting the reproductive care they need. On To the Point, researchers from George Washington University describe these obstacles and say greater investment in community health centers is needed to ensure people have timely and consistent access to perinatal care, to address maternity care deserts in rural communities, and to counteract misinformation about reproductive health and contraception options.
Maternal Health Organizations Need Access to Resources
Community-based organizations (CBOs) across the United States provide safe and culturally appropriate health care for underserved patients, including prenatal and maternal health services. But despite the critical role they play, CBOs often find it challenging to apply for and receive federal funding. On To the Point, experts from the Commonwealth Fund and Yale University report on findings from interviews with leaders and staff at six maternal health CBOs and make recommendations for better connecting with federal funding.
Lagging life expectancy, persistent health disparities, and a lack of access to affordable care are symptoms of a health system badly out of balance, especially given the enormous amount the U.S. spends on health care. Writing in Health Affairs Forefront, the Commonwealth Fund’s Joseph R. Betancourt, M.D., Milbank Memorial Fund’s Christopher Koller, and Arnold Ventures’ Mark Miller call for a course correction to strengthen primary care, the bedrock of a high-performing health system. They offer three recommendations, with the Medicare program in mind: pay for health improvement, not just medical services, by reimbursing clinicians with a blend of per-patient and per-service payments; increase primary care spending rates within current Medicare limits; and fix the flawed process used to value physician services.
Journalist Usha Lee McFarling Receives Bioethics Award
Usha Lee McFarling, national science correspondent at STAT and a 2024 Association of Health Care Journalists International Health Study Fellow (supported by the Commonwealth Fund), has been named the recipient of the 2024 Bernard Lo, M.D., Award in Bioethics. The award recognizes McFarling for her role in shaping the public discussion and policy debate about bioethics and equity in health care and research. A Pulitzer-prize winning science and health reporter, she brought her focus to inequities in health and medicine as they emerged from the COVID-19 pandemic. Her continued reporting on these disparities has become essential to public understanding on a number of issues, including racial differences in pulse oximeter functioning, disproportionate early departures of Black residents from medical training programs, and the lack of diversity in orthopedics.
In a new episode of The Health Management Academy’s CXO podcast, host Jasmaine McClain speaks with Joseph R. Betancourt, M.D., president of the Commonwealth Fund, about health equity and the work being done to improve health care for diverse populations. In a wide-ranging conversation, Betancourt highlights the Fund’s role in advancing health equity in every state and emphasizes the importance of addressing issues such as primary care, Medicaid payment and reimbursement, and the social drivers of health.
Professional services and consulting firm Aon recently reported that employers may see a 9 percent increase in health plan premiums in 2025. The estimated upturn is attributed to the rise to demand for high-cost prescription drugs and treatments, including gene and cell therapies. Read Transforming Care to learn about strategies employers are using to rein in costs, including increasing price transparency and steering employees to high-value providers.
QUIZ: Answer
The answer is D: 19 percent of Medicare beneficiaries are considered underinsured, meaning they spend at least 10 percent of their income on health care expenses other than premiums.
One of the reasons for Medicare Advantage plans’ popularity is their promise to make care more affordable for enrollees compared to traditional Medicare. But in their JAMA “Viewpoint,” the Commonwealth Fund’s Gretchen Jacobson and former Fund president David Blumenthal, M.D., write that recent research raises questions about whether this is true. Multiple surveys of Medicare beneficiaries indicate that the proportion who say their health care is affordable is no greater in Medicare Advantage than in traditional Medicare — and some evidence suggests that Medicare Advantage enrollees may have more problems affording care.
Affordable, quality health care. For everyone.
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