Latest / CareTalk: Healthcare. Unfiltered. / Why Millions Are Losing Medicaid

Transcript

Why Millions Are Losing Medicaid · CareTalk: Healthcare. Unfiltered.

• 0:00
  More than a million people, including hundreds of thousands of children lost Medicaid coverage in the last few weeks as the pandemic era, continuous coverage policy ended.
• 0:09
  Some states like Arkansas and Florida have moved quickly to purge the roles while others like Oregon and Wyoming are treading a more cautious and deliberate path.
• 0:19
  Three quarters of those who've been dropped lost coverage because their paperwork were missing or incomplete, and it doesn't automatically mean that they wouldn't qualify.
• 0:35
  Welcome to Care Talk, America's home for incisive debate about healthcare, business, and policy.
• 0:39
  I'm David Williams, president of Health Business Group.
• 0:42
  And I'm John Driscoll, the president of Walgreens Health.
• 0:45
  John, I know you just can't get enough care talk, so I have some good news for you because the care Talk I do.
• 0:50
  The Care Talk newsletter goes deeper into topics that are covered on the show.
• 0:54
  It's a convenient and reliable way to stay informed on the must know happenings in healthcare business policy and innovation.
• 1:00
  Make sure to click that link in the description.
• 1:03
  To subscribe.
• 1:05
  So David Medicaid is the program that covers people who are poor and, and lack, uh, insurance coverage and, and pays for their healthcare coverage.
• 1:16
  The vast majorities are really individuals with really complex illness, particularly in the dual eligibles that are covered by Medicare and Medicaid.
• 1:25
  Then there's the vast majority of, of folks who were on Medicaid.
• 1:29
  50% of the.
• 1:30
  People covered by Medicaid are children under the age of 18, and so there's a lot of families here.
• 1:36
  Uh, what's, what's, what's going on, John?
• 1:39
  During the pandemic, they had this thing called continuous coverage in public health emergency, and they said they're gonna add people to Medicaid.
• 1:45
  As you remember, a lot of people were losing their jobs, and so the number of people on Medicaid went from 70 to a million to 95 million people over that time because you could bring somebody in, but you couldn't kick 'em off.
• 1:55
  Now that the public health emergency ended.
• 1:58
  They said, okay, now we're gonna do what we call redetermination.
• 2:01
  Now you're gonna go back and look at everybody on Medicaid and see if they're actually still eligible.
• 2:05
  The result, John has been that more than 1.3 million people were removed from the Medicaid rules from the start of April through mid-June, and that's based on data from just 22 states.
• 2:15
  It's probably more a million people got got dropped from their health insurance.
• 2:20
  That's massive.
• 2:21
  Now there's good reasons for at least, you know, looking at that 72 to 95 million.
• 2:28
  Boom, because, you know, at the beginning of the pandemic, a lot of people didn't have jobs.
• 2:32
  I mean, every food and service workers get fired, and I'm sure a lot of people got hired back.
• 2:37
  But it seems like this, this, this bureaucratic word redetermination is sort of coverage for kind of cutting Medicaid coverage.
• 2:46
  Do you think it's fair, John, something like, uh, 74% of the people that were dis-enrolled or were dis-enrolled for so-called procedural reasons, that means.
• 2:56
  That they had the technicality of not completing their paperwork, it doesn't mean that they were actually ineligible for coverage.
• 3:02
  Now, that could happen because the state doesn't have the right contact information.
• 3:05
  It could happen because, you know, somebody who was unemployed all of a sudden has a, you know, in that time, has a good job.
• 3:12
  They have insurance and they don't need it, so they don't fill out the paperwork for that reason.
• 3:15
  So, no, it's not totally fair, John.
• 3:17
  For sure it's not fair.
• 3:18
  Well, and, and, and I mean, in fact, you could be dropped just because the states don't even know how to contact you.
• 3:24
  I mean, there, there's a lot of nitpicky aspects here, whether it's providing the paperwork, whether the states have the right location, whether they've even got the right files.
• 3:33
  Um, and, and, and, and that's, I mean, so David, I mean, 72 to 95, that that could be over 20 million people losing coverage.
• 3:42
  If that was a steady state number.
• 3:44
  That's gotta be, um, That's gotta be problematic for sure, John, especially for those that, uh, uh, did lose coverage without having some other coverage in place.
• 3:54
  And there's a lot of reasons why that could happen.
• 3:56
  John.
• 3:56
  I think we learn a lot from seeing the variations from state to state, because as you've, uh, lectured before, Medicaid is a joint federal state program.
• 4:04
  So each state runs it a little bit differently and you see that in the case of Arkansas, they're charging right ahead.
• 4:10
  They're gonna say, I'm gonna get every, I'm gonna go through all the redetermination in six months.
• 4:14
  Rather than one year, which is what Medicaid, uh, recommends.
• 4:17
  So they've ton, they've knocked a ton of people off the rolls.
• 4:20
  Whereas if you look on the other end of the spectrum, Oregon said they're not gonna disenroll anybody before October.
• 4:27
  So, Or Wyoming, where they're gonna be, be, be, is slow walking.
• 4:31
  I mean, I think that what people have to look at here is there, there is a, there is a partisan divide around whether you wanna be generous around extending insurance coverage at the margins, which would be the democratic point of view and would be, and continuous coverage would be a as, as is clearly associated with better health outcomes and the Republican perspective, which is.
• 4:57
  Medicaid is bankrupting the states, which is legit.
• 4:59
  Um, it is, the costs keep going up.
• 5:02
  It's a federal and state match, so it hurts the taxpayers in both places.
• 5:05
  If there's any question about whether someone should be, have their insurance premiums covered by the state.
• 5:11
  Uh, that should be a high bar.
• 5:13
  And, but unfortunately, the, the machine of big government does not always work efficiently or effectively, particularly in poor neighborhoods.
• 5:22
  And so I think the, the challenge is, unless this is done well, you're gonna have a lot of, potentially, as you alluded to, people who should ha get coverage off of coverage.
• 5:32
  John, there's definitely a, a political element to this, but there's a pragmatic part of it as well.
• 5:37
  And I think, you know, your point about, uh, Wyoming.
• 5:39
  Uh, which is a Republican state.
• 5:42
  Uh, in general, they're being cautious and not dropping people until, July or August due to paperwork.
• 5:47
  Let's describe why that could happen.
• 5:49
  So it's one thing if people aren't eligible, and I think there's, nobody had actually said, Hey, let's keep the continuous coverage in effect.
• 5:56
  And once you're on Medicaid, you keep it for life.
• 5:58
  You know, they've talked about, okay, if you're not eligible, then eventually you roll off of it.
• 6:02
  Now what happens if somebody is actually eligible but they didn't complete their paperwork?
• 6:07
  Here's a scenario that could occur.
• 6:08
  John.
• 6:09
  Let's say somebody with asthma.
• 6:10
  They can't afford their medication anymore, which used to be covered by Medicaid.
• 6:14
  They stopped taking it and they end up in the emergency room.
• 6:17
  When they're in the emergency room, they are unable to pay.
• 6:20
  So the hospital and maybe the state has to absorb the cost.
• 6:23
  And then what's gonna happen is the social worker at the hospital is gonna help 'em.
• 6:27
  They say, Hey, you're eligible for Medicaid.
• 6:28
  I'm gonna help you fill out the forms, and then they're gonna be back on Medicaid.
• 6:32
  They'll have worse health.
• 6:33
  It's gonna hurt the economy cuz they couldn't work.
• 6:35
  The hospital's gonna be hurt, et cetera.
• 6:36
  So I think regardless of political view, there is a pragmatic reason not to disenroll people, just cuz their paperwork wasn't turned in on time or complete.
• 6:45
  So David, how do you respond to the Republicans who would say, wait a second, this whole thing is needs-based and the paperwork determines the needs.
• 6:53
  Like, why are you, why are you creating these loopholes?
• 6:56
  That are allowing, it would allow people to get on and say, get coverage and stay on coverage when they haven't really earned it or deserve it.
• 7:04
  John, I have master's degree from a renowned institution.
• 7:07
  I.
• 7:07
  And yet when I get some uh, government forms, paperwork to fill in it, it's easy to make a mistake.
• 7:13
  And it's also easy to ignore it, especially if they've been sending things for three years and it turns out that, well, you don't need to fill it in cuz you're, you keep your coverage.
• 7:21
  So, you know, we don't expect people just to know.
• 7:24
  That they're supposed to fill it in.
• 7:25
  Okay.
• 7:25
  Whoa.
• 7:25
  The thir first three times weren't real, but the fourth time is real and you better fill all this information in.
• 7:30
  And so it's a really big burden for people to fill forms in, to fill them in, uh, correctly, even if they get it.
• 7:36
  What I would say, John, is that the way to deal with this is actually to make it more customer service oriented and to streamline it.
• 7:41
  There is this thing you tease me in January when I said ex parte, uh, verification, which means taking state records information they already have.
• 7:49
  Instead of making people fill in their income that's already filed with an income tax, for example, you should be able to do that automatically.
• 7:55
  So, but you're arguing it.
• 7:56
  You're arguing for a more efficient and simpler government.
• 7:59
  You're not saying that people shouldn't be thrown off the rolls as it will.
• 8:04
  I wouldn't throw anybody off John, cuz it could cause a new injury and land up in the emergency room for that.
• 8:08
  However, uh, yeah, I think you gotta really be more empathetic and just say, you know, Arkansas is saying, Hey, you didn't fill your paperwork in.
• 8:16
  Uh, you're out.
• 8:17
  You know, and you're, and you're out.
• 8:18
  Well, my favorite, my favorite is the, is the, is the, uh, the Republic of Florida where they say your, your, your, your Medicaid coverage has ended.
• 8:26
  Yeah.
• 8:26
  Is if you have no access to a, to to determination, which would be the opposite of.
• 8:33
  Redetermination that to, to allow yourself to get back on the roles.
• 8:37
  I mean, there's no question that, that this legitimate rebalancing of insurance coverage and, and where people are in terms of employment, um, has been manipulated in certain states to just solve a short term budget problem.
• 8:52
  And look, there are people who I know, David, you're not one of them judge folks because they're poor.
• 8:57
  And on Medicaid, Medicaid's sort of an essential part of the healthcare system and for some parties in some states, and it's showing up in the way that they are determining.
• 9:06
  We're not, we're not arguing that there shouldn't be redeterminations, but I just like even a red state like Wyoming saying that we are not gonna, you know, uh, quickly excise people from the roles.
• 9:18
  Just because of a, a, a A, you know, a, a paper error.
• 9:23
  So, John, we're pointing out the problems.
• 9:24
  Is anybody working on the solutions here at the federal level?
• 9:27
  State level?
• 9:28
  Anybody else stepping in to help out?
• 9:30
  Well, I mean, I, I think people are poking around.
• 9:33
  I mean, Javi RA wrote sort of a generic warning letter.
• 9:38
  Um, Congress has been warning CMS that they're really concerned about the way this is happening, but, We don't really have a consistent way to look at red states and blue states here to make sure that Medicaid eligibles those poor people who are getting coverage through Medicaid and who have, who deserve it, are equally well protected.
• 9:58
  So I've seen nothing other than we're on uncomfortable with some of the activities in certain states, uh, because the states do have a fair amount of flexibility to, to execute on the management of their plans.
• 10:09
  I have not seen much more than that.
• 10:11
  Have you, have you heard about anything that would kind of create more of an intelligent path forward?
• 10:16
  The idea when this, um, redetermination was agreed, was that there would be a variety of actors that could, could help, so that it's supposed to be a smooth process and not.
• 10:25
  Uh, one that is, is so arbitrary and I think some of what, uh, Bera was saying and, and what the, the congressional Democrats are asking for is, okay, let's see the plans, let's see the progress.
• 10:35
  Let's encourage people to slow down if they're going too quickly.
• 10:38
  There are some other players explicitly beyond government that are, uh, supposed to be able to help out here.
• 10:44
  One clearly that has an incentive is the, uh, Medicaid managed care organizations because they receive the premium, so they're trying to help people fill out the paperwork and they'd probably like more of an opportunity to do that there.
• 10:57
  The Sarah reminded the states that there are others they could work with.
• 10:59
  The schools, faith, faith-based groups, pharmacies and community organizations that can help.
• 11:05
  Uh, with the paperwork as opposed to just the example I gave, if somebody hands up in the emergency room, yeah, they're gonna get help.
• 11:10
  Um, there.
• 11:11
  So I don't know the extent to which those players can step up if the states aren't interested, but there are other players that are you being encouraged to step forward.
• 11:21
  I think that's true, David, but it, but it still does, you know, if, if certain states are determined to actually, you know, flush folks from the roles that's gonna happen.
• 11:31
  I mean, I, I, I, I don't see a, an easy an, an, an easy path back.
• 11:37
  I mean, they have, there's legitimate concern that the growth in Medicaid.
• 11:41
  Is not consistent with what a lot of these states can can handle.
• 11:44
  I, I'd like to see more uniform standards on that.
• 11:46
  Well, passer is encouraging people to leverage community-based resources.
• 11:50
  It's hard to believe those community-based resources are going to be encouraged in states where some of the leadership would be very happy if Medicaid was just smaller.
• 11:59
  So let's, we mentioned before that a lot of kids are on the roll, like half of kids or more that are born in the US are on, uh, Medicaid and they're Medicaid eligible at least.
• 12:08
  And here's an example of the sort of tricky paperwork, which is that the income requirements, uh, for family to receive Medicaid differ for the kids to receive it versus the parents to receive it.
• 12:19
  So some people are in an intermediate spot where their income is too high for the parents to receive Medicaid, but the kids could get it.
• 12:26
  And so I think.
• 12:28
  Publicizing that and what that is in various states could be helpful, uh, even to get to people individually because they're probably saying, oh, you know, I have a job.
• 12:35
  I make too much for Medicaid.
• 12:36
  It may have a certain amount.
• 12:37
  Well, it, it may turn out that they, the kids could be covered.
• 12:40
  It should be no, and, and, and your ID requirements vary by state some of your, uh, you know, some, the, the.
• 12:48
  Th th look, anybody who's filled out an IRS form, let alone has, has, has tried to figure out some of the questions at, uh, at even a, um, you know, e e even a, the, the, the Registry of Motor Vehicles realizes that this is not, that, that government does not provide the greatest, the best ui.
• 13:08
  I mean, what's interesting is you actually would have.
• 13:11
  With current technology tools, the ability to kind of simplify and make coherent a lot of these things.
• 13:18
  But a lot of the states are still tied to physical records, uh, green screens and, and old technology.
• 13:24
  I mean, the opportunity really, he would be here, David, if the feds would create a uniform digital standard that would allow people to actually manage their information online, and I think that would be fair.
• 13:35
  Right now, each state is different and I think it's a failure of policy.
• 13:40
  That the Feds didn't set up a standard for keeping or dropping and notification and communication the same way they do with the aca.
• 13:48
  Uh, it's, it's, it's, I think it's, I think it's an error of execution there.
• 13:52
  That's fair, John.
• 13:53
  Well, the feds have shown that they can do things.
• 13:55
  I mean, president Biden and announced that they're gonna fix this, uh, this highway in Pennsylvania, notably a swing state in two weeks instead of, uh, two years or whatever it was gonna take otherwise, maybe there's something similar here.
• 14:05
  What do you think is gonna happen next, John?
• 14:07
  He's a bridge in, he's more of a bridge and tunnel guy than he is a, a digital guy, Dave.
• 14:12
  But I still think, but I, but I take your point.
• 14:15
  Sorry.
• 14:15
  What?
• 14:16
  So what do I think is gonna happen?
• 14:17
  I, I think that what'll happen is, what has happened historically is that Blue States will manage to keep and maintain more coverage, and red states are gonna quickly excise their states of, of folks who.
• 14:30
  Who, just from the roles, regardless of whether they deserve to be there or not.
• 14:33
  And I think that what this points out is that, uh, the, the real need for a universal standard and a much better and easier user interface.
• 14:44
  I think as the Republicans have become the party to some extent of the working class, you know, it's more likely Republicans are more likely to be on Medicaid than Democrats, uh, that you may actually see some of the pragmatism, which does occur at the gubernatorial level within states.
• 14:57
  Uh, and that some states may learn, uh, from the Wyomings that are out there and actually, uh, be a little bit more empathetic.
• 15:03
  And I, I think that the Democratic states may, you know, may make their own blunders as well.
• 15:07
  So I don't put it so much in red.
• 15:09
  And I, and I, and I think that there's, there's a, there are three categories of people who are gonna be affected here.
• 15:14
  One is the people who are.
• 15:17
  Going to be redetermined out, which is, you know, purged in your words from the roles and who have jobs and have coverage, and they're gonna be fine.
• 15:28
  And then there's a group of people who, um, have the right paperwork and can stay on.
• 15:33
  Um, and then there's folks who are deserve to, or could be, could qualify, or should qualify, do qualify for.
• 15:41
  Medicaid insurance coverage will be dropped.
• 15:43
  They will seek free care at hospitals and from doctors, and if they get sick, they'll be end up hospitalized and we'll end up paying the bill.
• 15:51
  This isn't purely out of the goodness of our heart, although I think we owe it to poor people in America to make sure that they've got continuous coverage.
• 15:58
  Just that's my opinion.
• 16:01
  But this is a the As, as as was shown over and over in the case of the aca, if we can actually get people coverage who are vulnerable.
• 16:10
  To chronic illness and keep them covered.
• 16:12
  It's going to lower the total cost of care for all Americans and actually help the taxpayer because if you pursue free care at the hospital and you get ta get taken care of by a lot of expensive care, uh, that ends up being subsidized eventually by the taxpayer.
• 16:26
  So we're paying either way.
• 16:28
  Well, John, that's it for yet another episode of Care Talk.
• 16:30
  We've been talking about the great Medicaid unwinding after the end of the public health emergency.
• 16:36
  I'm David Williams, president of Health Business Group, and I'm John Driscoll, the president of Walgreens Health.
• 16:41
  If you liked what you heard or you didn't, we'd love for you to subscribe on your favorite service.