Mayor Reed: Time to expand Medicaid
Atlanta Mayor Kasim Reed, who has faced criticism for his relatively quiet position on Medicaid expansion in Georgia, joined a handful of mayors on a White House-led call Wednesday advocating expansion in their states. Reed, a rising star on the Democratic stage, is a noted ally of Republican Gov. Nathan Deal, a staunch Obamacare opponent. Deal has said repeatedly that Georgia can’t afford to expand Medicaid.
Reed said nearly 400,000 Georgians would benefit from an expansion. Without it, he said, Grady Memorial Hospital could lose nearly $100 million in annual payments from the federal government for providing charity care. And rural hospitals, Reed said, could be “significantly weakened or forced to close,” he said.
Reed joined Milwaukee Mayor Tom Barrett and Philadelphia Mayor Michael Nutter on the call.
“Let’s do the right thing and cover these 400,000 individuals who can be added to our Medicaid rolls simply by a decision,” he said.
Reed did not specifically call out Deal in his remarks. But when asked by a reporter how he planned to work with the governor, Reed said he’s having private conversations with Deal and other state leaders.
Reed said Deal is concerned about the cost of implementation – estimated at $2.5 billion to $4 billion the state would have to pay over a decade — and therefore he’s helping devise a way to address that issue. Reed said he believes the $33 billion the state would receive over that 10-year-period in federal funds is “worth figuring out” how to pay the cost.
“The long-term benefit of having a healthier population is worth implementing and embracing the Medicaid option right away.”
Just 536 Georgians successfully enrolled in a new health plan during the first month of business for the haywire Health Insurance Marketplace, state officials said Wednesday.
The same day, in Washington, Health and Human Services Secretary Kathleen Sebelius made the federal government’s first report on how the marketplace performed from Oct. 1 through Nov. 2: about 106,000 people got far enough on the exchanges, both state and federal, that they were able to select an insurance plan. Not all of them had paid for the plan yet.
That number — actual paid enrollments — was absent from Sebelius’ report. The federal data showed that 1,390 Georgians had selected a marketplace plan, but Georgia’s numbers showed that only 536 had actually completed enrollment.
“Whatever the numbers are – they don’t tell us a dang thing,” said Georgia State University health care expert Bill Custer.
Custer said that even if the marketplace had been working perfectly, most people would not have enrolled in the first month anyway. It’s a complicated decision that people will take time to make, he said.
The government had refused until Wednesday to release extensive data on the exchanges and had spent weeks trying to dampen expectations for when the report finally did come out. And in fact, of the 106,000 people who have selected a plan, three-quarters signed up on state-run exchanges. Only about 27,000 were able to do so on the federal exchange site.
Sebelius asserted that the troubled marketplace website is improving by the week and should be accessible to the “vast majority” of people by the Nov. 30 deadline she set.
“It’s running right now,” she said during a conference call with reporters. “Every day people are coming through. Every day people are getting enrolled… . Today is quite a bit better than it was on Nov. 1. The website is very much open for business.
Georgia Insurance Commissioner Ralph Hudgens said more than 1,400 applications were sent on to Georgia insurance companies from the marketplace in October.
While 536 of those applications could immediately be processed by insurers, the rest were either duplicates, incomplete applications or had other problems that prevented insurers from being able to finalize the policy with the consumer.
Hudgens got the numbers from the state’s insurers, not from the federal government.
“HHS is really not talking to us,” Hudgens said. “The information is not flowing very freely back and forth.”
What insurers and policy makers will really need to know, Custer said, is whether the marketplace is attracting a mix of young and healthy people, along with older, sicker consumers and those with pre-existing conditions.
The Affordable Care Act bans insurers from turning down people for coverage due to health issues. The cost of caring for those consumers was supposed to be balanced by the “individual mandate” – the requirement that most Americans buy insurance or face a penalty.
Consumers need to sign up by Dec. 15 if they want coverage to start on on January 1.
Custer said enrollment figures after that deadline will shed more light on how the marketplace is working, both in terms of overcoming its technical difficulties and attracting customers.
“We still may not know what the actual risk pool will look like – what percentage of healthy vs. not healthy people will enroll,” he said. “one of the reasons is the mandate deadlines keep getting pushed back.”
Consumers who sign up by March 31 are considered in compliance with the mandate for coverage.
Other key numbers reported by the federal government Wednesday:
- State and federal exchange sites had 27 million unique visitors during the first month, and state and federal call centers fielded 3.2 million calls.
- 975,000 people were determined eligible to select a plan but have not yet done so.
- About 30 percent of the people eligible to shop on the marketplace qualified for a federal tax credit.
- Nearly 400,000 people were determined to be eligible for Medicaid or CHIP, the public insurance programs for low-income people. That number in Georgia was 7,709.
Under a Supreme Court ruling, each state can decide whether to approve a massive expansion of Medicaid as called for by the Affordable Care Act.
Even though Georgia rejected the Medicaid expansion, the state anticipated that people who were currently eligible for the program but had not signed up would discover that through HealthCare.gov.
State officials could not immediately confirm the accuracy of the Medicaid figures reported by HHS.
Hudgens described the enrollment numbers for private insurance as “very, very low.”
“It doesn’t bode real well for a successful sign-up period,” he said.
Hudgens said most consumers he’s talked to have not been able to sign up due to HealthCare.gov’s technical problems.
“Every report I have gotten is they are very, very, very frustrated that they have not been able to get on,” he said. “I have tried to get on myself and gone through about step 2 or 3 and then it tells me I can’t go any further.”
Hudgens said he has advised consumers not to try to sign up yet.
“The president has assured us by Dec. 1 that all the kinks will be worked out and it will be up and running,” Hudgens said. “So I’m going to take him at his word. I tell people save yourself a lot of frustration and wait until Dec. 1 and try to get on HealthCare.gov.”
Low numbers on the exchange
The federal government released data Wednesday showing how the federal Health Insurance Marketplace, or exchange, worked during its first flawed month. For selected states below, “complete applications” refers to people who were able to establish accounts and finish applications. “Selected marketplace plan” means people who went all the way through the process and chose a new insurance plan, although not all of the people in this column paid for the plan. Georgia officials said only 536 people in the state had actually finished enrollment.
Source: U.S. Department of Health and Human Services
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