NN&I - May 2010
20 Nephrology News & Issues May 2010www.nephronline.com and $29,327 for a family of four in 2009). This move alone extends coverage to 37% of all the uninsured in the United States (17.1 million adults). The expansion of Medicaid is the easiest way to extend coverage to the largest number of people at the lowest cost. But it also invites the criticism that it puts more people into a well-meaning but flawed system. Though Medicaid is cost effective on a per-person basis and is a good investment for states (based on the federal match), the recent increase in enrollment has overwhelmed state budgets enough to blunt these advantages. According to the 2009 Fiscal Survey of States from the National Association of State Budget Officers and the National Governor's Association: The weak fiscal conditions of states resulted in numerous act-ions to control Medicaid spend -ing even with federal relief from ARRA. Twenty-seven states in fiscal 2009 and 28 states in fis-cal 2010 made program cuts in Medicaid due to these fiscal diffi-culties. Nearly every state imple-mented at least one plan to con-trol Medicaid spending in fiscal 2009 and fiscal 2010 according to the annual survey on state Medicaid budgets by the Kaiser Commission on Medicaid and the Uninsured. The most common strategy involved reductions to provider reimbursements. Thirty-three states cut or froze provider rates in fiscal 2009 while thirty-nine states are planning to cut or freeze rates for fiscal 2010.7In Florida, Medicaid rates for primary care are about 55% of Medi-care. These low rates of reimbursement and the "hassle factor" of Medicaid limits access to high quality care, and the expansion of Medicaid only in-creases the strain on an already over -burdened system. The new health care law seeks to relieve some of the pressure on state budgets by having the government pay 100% of the initial costs of Medicaid expansion (which is required begin -ning 2014) and then scale down its share until 2020, when it will pay for 90% going forward. Additionally, to address low payment for primary care, the government will pay for an increase in Medicaid payments to 100% of Medicare in 2013 and 2014.8,9 The law also includes many other provisions that impact Medicaid, some of which can be helpful for individuals with kidney disease. For example, it eliminates cost-sharing for preventive services; it improves access by increas-ing funding by $11 billion to community health centers; it extends and improves existing Medicaid demonstrations; and it creates new options and demonstra -tions to test out different models of care, including: Medicaid state plan option to per - \037 mit Medicaid enrollees to designate a medical home Medicaid state plan options to offer \037 home and community-based services Medicaid demonstration projects to \037 pay bundled payments for episodes of care Medicaid demonstration proj - \037 ects to allow for accountable care organizations Looking ahead Though the last year has been a whirlwind of controversy and misinfor -mation, one thing is clear: the sweep-ing reform enacted by the new law will improve the lives of people with kidney disease. All persons either at risk or being affected by chronic kidney disease will have guaranteed access to coverage at affordable rates, either through their employer, a state-based insurance exchange, Medicaid, and/or Medicare. Additionally, everyone will have access to treatment that will help manage his or her risk factors or chron -ic conditions. But as the Massachusetts experiment has shown, coverage is only the first part of the journey that is health reform. References1. Kaiser Health Tracking Poll March 2010. http://www.kff.org/kaiserpolls/8058.cfm. Accessed 4/8/2010. 2. Government Accountability Office. State High-Risk Health Insurance Pools (GAO-09-730R). http:// www.gao.gov/new.items/d09730r.pdf. Accessed 4/8/2010. 3. Issues for Structuring Interim High-Risk Pools. Kaiser Family Foundation. http://www.kff. org/healthreform/upload/8040.pdf. Accessed 4/8/2010. 4. Associated Press. Obama's health insurance rule-it was a GOP idea. http://www.google.com/ hostednews/ap/article/ \037 Up-to-the- minute news \037 Feature stories \037 Editorial blogs Go to NephrOnline.com. Get involved.The only renal website you need. www.nephronline.com20 Nephrology News & Issues May 2010 Health Care Beat HCB_NNI0510_2.indd 20 4/19/10 9:03:43 AM
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