June 5, 2018
June 04--Medicaid, as we know it, is the nation's
government-run health care program for the poor. You have to make below a
certain amount of money to qualify for it, and it's free for most. But what if people
-- regardless of their income -- could buy a Medicaid plan?
That idea is gaining popularity among state lawmakers.
Last year, a "Medicaid buy-in" or "Medicaid-for-all" bill
made it as far as the governor's desk in Nevada. Gov. Brian Sandoval vetoed it,
but it inspired similar efforts around the country.
Six states -- Iowa, Massachusetts, Minnesota, Missouri,
New Jersey and Washington state -- have active legislation to establish a
Medicaid buy-in program. In four others, bills were proposed but stalled. New
Mexico has set up a task force to study a Medicaid buy-in program, and
Connecticut may do the same.
The premise of these buy-in bills is like Nevada's:
Medicaid plans would be offered on each state's insurance marketplace, and
people who don't traditionally qualify for Medicaid could pay premiums and
co-pays. In Missouri, though, the Medicaid buy-in plans would only be expanded
to people who have a disability and are employed.
According to experts, each state likely has a different
reason for considering this option.
"States are still exploring what it would even
mean," says Heather Howard, director of State Health and Value Strategies.
"For one state, it could be about addressing a bare county. For another,
it could be an affordability issue. For another, it could be about expanding
competition. In the absence of federal legislation on health care, states are
asking: 'What tools do we have?'"
For left-leaning lawmakers, Medicaid buy-in is considered
a step toward single-payer health insurance. But conservatives are wary of
expanding the government's role in health care and of funneling more money into
Medicaid, which is already a huge slice of state budgets.
New Mexico state Sen. Jerry Ortiz y Pino -- who
co-sponsored a bill to study the issue -- says Medicaid buy-in makes sense
there because the majority of residents (54 percent) already have Medicaid or
Medicare. It's the only state where more than half the population uses
government health care.
"Besides Medicaid, we have a high Medicare
population, high VA [Veterans Affairs] population and high numbers in the
Indian Health Service," says Ortiz y Pino. "So when we talk about
non-governmental insurance, it's a small number. That small population means
it's hard to attract private insurers, particularly in the marketplace."
New Mexico's marketplace has four insurers covering the
state, which is actually more than many part of the country. About half of
Americans only had one or two insurers last open enrollment season. Still, like
most other states, New Mexico's marketplace is facing increased premiums and
possible insurer dropouts this year.
Despite the spike in interest, Medicaid buy-in is unlikely
to be implemented -- or even passed -- in any state this year. The bills that
still have a chance have barely moved. There's even hesitation in blue states
-- like Maryland, which killed buy-in bills this year. As health care
uncertainty on the federal level continues -- Congress reportedly may try again
this year to repeal the Affordable Care Act -- some think it's too risky of a proposition
to take on right now. And it's unlikely the Trump administration would agree to
pay for additional costs of a buy-in, putting any new financial burden squarely
on states.
"It's hard to say if it'll catch on. It's a crystal
ball question. But I will say that states are interested. We had a session at
the end of our conference about Medicaid buy-in, and it was packed," says
Anita Cardwell, a policy associate with the National Academy for State Health
Policy.
If New Mexico does move forward with a buy-in option, it
wouldn't be the most generous of plans, says Ortiz y Pino. He expects they
would offer all that's required, like mental health and maternity care, but
that the plans would be more like "Medicaid lite."
"It would cover the basics. I don't think we could
have long-term care, for instance. But I do think we could put together a nice
package of benefits," he says.
New Mexico's study is expected to be complete by
Thanksgiving. Depending on the results, Ortiz y Pino hopes the legislature can
file an official Medicaid buy-in bill in early 2019.
"This is our shot at this," he says. "If
the numbers look right, of course."
Mattie Quinn -- Staff Writer -- mquinn@governing.com --
@mattiekquinn
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