Medicaid Waivers Should Backstop The Exchanges

During the summer of 2017, there were 82 counties at risk of not being covered for the 2018 policy year. State regulators managed to attract at least one insurer in those counties, but a recent market exit in Virginia leaves more counties at risk. The recent Health Affairs Blog post by Anderson, Hacker, and Starr, which advocates for a persistent Medicare-derived public option that is triggered by insufficient competition on the Affordable Care Act (ACA) exchanges, is an interesting example of harnessing the power of Medicare and repurposing it to compete in the private market. Bare counties and the lack of meaningful choice on the exchanges are significant policy concerns. If we are to use a pre-existing structure to guarantee that every county will have at least one insurer, Medicare and Medicare Advantage is not the optimal choice. The benefit structure is too complex. The covered population is significantly different than the individual market populations: Medicare beneficiaries have more comorbidities and are older than the individual market beneficiaries. They also change plans far less often. Finally, the Centers for Medicare and Medicaid Services (CMS) is too removed from local conditions to design a plan that meets the local needs. Instead, Medicaid is better suited as a reserve parachute for bare counties. Temporary Medicaid buy-in would be a useful tool for state regulators to improve the quality of plans offered in counties that otherwise would have been bare. ...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Following the ACA Medicaid and CHIP bare counties 1332 waivers Section 1115 Waivers Source Type: blogs