{"id":13773,"date":"2017-11-10T19:17:00","date_gmt":"2017-11-10T19:17:00","guid":{"rendered":"http:\/\/associatednews.us\/content\/2017\/11\/10\/medicaid-expansion-takes-a-bite-out-of-medical-debt\/"},"modified":"2017-11-10T19:17:00","modified_gmt":"2017-11-10T19:17:00","slug":"medicaid-expansion-takes-a-bite-out-of-medical-debt","status":"publish","type":"post","link":"https:\/\/associatednews.us\/content\/medicaid-expansion-takes-a-bite-out-of-medical-debt\/","title":{"rendered":"Medicaid Expansion Takes A Bite Out Of Medical Debt"},"content":{"rendered":"<p><span style=\"font-style:italic;font-size:16px\">By  <a class=\"colorbox\" href=\"https:\/\/www.npr.org\/sections\/health-shots\/2017\/11\/10\/563029459\/medicaid-expansion-takes-a-bite-out-of-medical-debt?utm_medium=RSS&amp;utm_campaign=healthcare\">Alex Smith<\/a><\/span>  <\/p>\n<div class=\"ftpimagefix\" style=\"float:left\"><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.npr.org\/sections\/health-shots\/2017\/11\/10\/563029459\/medicaid-expansion-takes-a-bite-out-of-medical-debt?utm_medium=RSS&amp;utm_campaign=healthcare\"><img decoding=\"async\" width=\"150\" src=\"https:\/\/media.npr.org\/assets\/img\/2017\/11\/09\/img_7253-7cee9b63a14a5937cc9f68e799865cf424bc05a8-s1100-c15.jpg\" alt><\/p>\n<div><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/media.npr.org\/assets\/img\/2017\/11\/09\/img_7253-7cee9b63a14a5937cc9f68e799865cf424bc05a8-s1200.jpg\"><\/a><\/div>\n<div>\n<div>\n<div><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/media.npr.org\/assets\/img\/2017\/11\/09\/img_7253-7cee9b63a14a5937cc9f68e799865cf424bc05a8-s1200.jpg\">Enlarge this image<\/a><\/div>\n<\/div>\n<div>\n<div>\n<div>\n<p>\n                Medical debts weigh on Geneva Wilson, who keeps a chicken and rooster in a coop behind her cabin in rural southwest Missouri.<\/p>\n<p>                <b><\/p>\n<p>                    Alex Smith\/KCUR 89.3<\/p>\n<p>                <\/b><b><b>hide caption<\/b><\/b><\/p>\n<\/div>\n<p><b><b>toggle caption<\/b><\/b><\/div>\n<p><span><\/p>\n<p>        Alex Smith\/KCUR 89.3<\/p>\n<p>    <\/span><\/div>\n<\/div>\n<p>As the administration and Republicans in Congress look to scale back Medicaid, many voters and state lawmakers across the country are moving to make it bigger.<\/p>\n<p>On Tuesday, Maine voters approved a ballot measure to expand Medicaid under the Affordable Care Act. Advocates are looking to follow suit with ballot measures in Utah, Missouri and Idaho in 2018.<\/p>\n<p>Virginia may also have another go at expansion after the Legislature thwarted Gov. Terry McAuliffe&#8217;s attempt to expand Medicaid. Virginia voters elected Democrat Ralph Northam to succeed McAuliffe as governor in January, and Democrats made inroads in the state legislature, too.<\/p>\n<p>An exit poll of Virginia voters on Election Day found that 39 percent of them <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/khn.org\/news\/election-night-surprise-health-care-galvanizes-voters\/\">ranked health care<\/a> as their No. 1 issue. More than three-quarters of the Virginians in this group voted for Democrats.<\/p>\n<p>A <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.urban.org\/research\/publication\/past-due-medical-debt-among-nonelderly-adults-2012-15\">study<\/a> from the Urban Institute may shed some light on why Medicaid eligibility remains a pressing problem: medical debt. While personal debts related to health care are on the decline overall, they remain far higher in states that didn&#8217;t expand Medicaid.<\/p>\n<aside>\n<div><\/div>\n<\/aside>\n<aside>\n<div><\/div>\n<\/aside>\n<p>In some cases, struggles with medical debt can be all-consuming.<\/p>\n<p><!-- END ID=\"RES563030408\" CLASS=\"BUCKETWRAP INTERNALLINK INSETTWOCOLUMN INSET2COL \" --><\/p>\n<p>Geneva Wilson is in her mid-40s and lives outside of Lowry City, Mo. She has a long history of health problems, including a blood disorder, depression and a painful misalignment of the hip joint called hip dysplasia.<\/p>\n<p>She&#8217;s managed to find some peace living in a small cabin in the woods. She keeps chickens, raises rabbits and has a garden. Her long-term goal is to live off her land by selling what she raises at farmers markets.<\/p>\n<p>Her health has made it hard to keep a job and obtain the insurance that typically comes with it. And Missouri&#8217;s stringent Medicaid requirements \u2014 which exclude nondisabled adults without children<strong> \u2014 <\/strong>have kept her from getting public assistance.<\/p>\n<p>Since graduating from college more than 20 years ago, Wilson has mostly had to pay out of pocket for medical care, and that&#8217;s left her with a seemingly endless pile of medical debt.<\/p>\n<p>&#8220;As soon as I get it down a little bit, something happens, and I have to start all over again,&#8221; Wilson says.<\/p>\n<p>Right now her medical debt stands at about $3,000, which she pays down by $50 a month. She desperately needs a hip replacement, but she canceled the surgery because, even with deeply discounted rate from a nearby hospital, she can&#8217;t afford it.<\/p>\n<p>&#8220;Approximately $11,000 is what would come out of my pocket to pay for the hip. That&#8217;s my entire pretax wage from last year,&#8221; Wilson says. &#8220;So it&#8217;s kind of on hold, but I don&#8217;t know if I can survive the year without going ahead and trying to get it done.&#8221;<\/p>\n<p>For many people like Wilson, medical debt can be nearly as problematic as their illness. In 2015, <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.urban.org\/research\/publication\/financial-knowledge-associated-past-due-medical-debt\">30.6 percent of Missouri adults<\/a> ages 18 to 64 had past due medical debt, the seventh-highest rate in the country. Kansas, at 27 percent, had the 15th highest rate. In Maine, which voted to expand Medicaid this week, it was 27.7 percent.<\/p>\n<p>Researchers Aaron Sojourner and Ezra Golbertstein of the University of Minnesota studied financial data from 2012 to 2015 for people who would be eligible for Medicaid where it was expanded.<\/p>\n<p>They found that in states that didn&#8217;t expand, the percentage of low-income, nonelderly adults with unpaid medical bills dropped from 47 to 40 percent within three years.<\/p>\n<p>&#8220;The economy improved and maybe other components of the ACA contributed to a 7 percentage point reduction,&#8221; Sojourner says. &#8220;Where they did expand Medicaid, it fell by almost twice as much.&#8221;<\/p>\n<p>Those states saw an average drop of 13 percentage points, from 43 to 30 percent.<\/p>\n<p>In Kansas, the rate of medical debt for nonelderly adults fell by 4 percentage points to 27 percent. In Missouri, the rate dropped 4 points to 31 percent, according to the Urban Institute. In Maine, it dropped only 1.4 percentage points between 2012 and 2015.<\/p>\n<p>Medicaid, as opposed to private insurance, is the key, says The Urban Institute&#8217;s <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.urban.org\/author\/kyle-j-caswell\">Kyle Caswell<\/a>, because it requires little out-of-pocket costs.<\/p>\n<p>Even if Medicaid patients need lots of care, there aren&#8217;t on the hook for big out-of-pocket costs in the same way someone with private insurance might be.<\/p>\n<p>&#8220;We would certainly expect that their risk to out-of-pocket expenses to be much lower, and ultimately the risk of unpaid bills to ultimately be also lower,&#8221; Caswell says.<\/p>\n<p>But Medicaid&#8217;s debt-reducing advantages over private insurance could disappear under the leadership of the Trump administration.<\/p>\n<p><!-- END ID=\"RES563318390\" CLASS=\"BUCKETWRAP INTERNALLINK INSETTWOCOLUMN INSET2COL \" --><\/p>\n<p>Shortly after Seema Verma was confirmed as the Administrator for the Centers for Medicare &amp; Medicaid Services, she and Tom Price, then head Department of Health and Human Services, sent <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.hhs.gov\/sites\/default\/files\/sec-price-admin-verma-ltr.pdf\">a letter<\/a> to the governors outlining their plans for Medicaid.<\/p>\n<p>The letter encouraged states to consider measures that would make their Medicaid programs operate more like commercial health insurance, including introducing premiums and copayments for emergency room visits.<\/p>\n<p>Verma says that by giving recipients more &#8220;skin in the game,&#8221; they will take more responsibility for the cost of care and save the program money.<\/p>\n<p>Republican proposals in Congress to repeal and replace the Affordable Care Act would have eliminated or limited Medicaid expansion. And that would have affected the last few years&#8217; downward trend in medical debt.<\/p>\n<p>&#8220;Anything that reduces access to Medicaid most likely would have the reverse effect of what of we&#8217;re seeing in our paper,&#8221; Caswell says. &#8220;Reduced access to Medicaid would likely increase exposure to medical out-of-pocket spending and ultimately unpaid medical bills.&#8221;<\/p>\n<p>As Geneva Wilson tends to her chickens, she says she tries not to think too much about her medical debt or how she&#8217;ll pay for that hip replacement.<\/p>\n<p>&#8220;It&#8217;s going to the point where, if I were to go shopping at Walmart, I would have to get one of the carts you drive because I can&#8217;t manage,&#8221; she says.<\/p>\n<p>Wilson has already sold her jewelry, some furniture and a wood stove to pay down her debts. Now there&#8217;s not much left to sell except her cabin and her land.<\/p>\n<p>&#8220;Probably the homestead and garden that I want, that I&#8217;ve been wanting and trying to work for, I don&#8217;t think they are a viable dream either,&#8221; Wilson says. &#8220;It&#8217;s hard losing your dreams.&#8221;<\/p>\n<p><em>This story is part of a reporting partnership with NPR, KCUR and <\/em><a class=\"colorbox\" rel=\"nofollow\" href=\"http:\/\/www.kaiserhealthnews.org\/\">Kaiser Health News<\/a>.<em> Alex Smith can be reached on Twitter at <\/em><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/twitter.com\/@AlexSmithKCUR\">@AlexSmithKCUR.<\/a><\/p>\n<p><strong><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/blockads.fivefilters.org\/\">Let&#8217;s block ads!<\/a><\/strong> <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/blockads.fivefilters.org\/acceptable.html\">(Why?)<\/a><\/p>\n<p>Source:: <a href=\"https:\/\/www.npr.org\/sections\/health-shots\/2017\/11\/10\/563029459\/medicaid-expansion-takes-a-bite-out-of-medical-debt?utm_medium=RSS&amp;utm_campaign=healthcare\" class=\"colorbox\" title=\"Medicaid Expansion Takes A Bite Out Of Medical Debt\" rel=\"nofollow\">https:\/\/www.npr.org\/sections\/health-shots\/2017\/11\/10\/563029459\/medicaid-expansion-takes-a-bite-out-of-medical-debt?utm_medium=RSS&amp;utm_campaign=healthcare<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<div class=\"ftpimagefix\" style=\"float:left\"><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.npr.org\/sections\/health-shots\/2017\/11\/10\/563029459\/medicaid-expansion-takes-a-bite-out-of-medical-debt?utm_medium=RSS&amp;utm_campaign=healthcare\"><img decoding=\"async\" width=\"150\" src=\"https:\/\/media.npr.org\/assets\/img\/2017\/11\/09\/img_7253-7cee9b63a14a5937cc9f68e799865cf424bc05a8-s1100-c15.jpg\" alt><\/p>\n<div><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/media.npr.org\/assets\/img\/2017\/11\/09\/img_7253-7cee9b63a14a5937cc9f68e799865cf424bc05a8-s1200.jpg\"><\/a><\/div>\n<div>\n<div>\n<div><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/media.npr.org\/assets\/img\/2017\/11\/09\/img_7253-7cee9b63a14a5937cc9f68e799865cf424bc05a8-s1200.jpg\">Enlarge this image<\/a><\/div>\n<\/div>\n<div>\n<div>\n<div>\n<p>\n                Medical debts weigh on Geneva Wilson, who keeps a chicken and rooster in a coop behind her cabin in rural southwest Missouri.<\/p>\n<p>                <b><\/p>\n<p>                    Alex Smith\/KCUR 89.3<\/p>\n<p>                <\/b><b><b>hide caption<\/b><\/b><\/p>\n<\/div>\n<p><b><b>toggle caption<\/b><\/b><\/div>\n<p><span><\/p>\n<p>        Alex Smith\/KCUR 89.3<\/p>\n<p>    <\/span><\/div>\n<\/div>\n<p>As the administration and Republicans in Congress look to scale back Medicaid, many voters and state lawmakers across the country are moving to make it bigger.<\/p>\n<p>On Tuesday, Maine voters approved a ballot measure to expand Medicaid under the Affordable Care Act. Advocates are looking to follow suit with ballot measures in Utah, Missouri and Idaho in 2018.<\/p>\n<p>Virginia may also have another go at expansion after the Legislature thwarted Gov. Terry McAuliffe&#8217;s attempt to expand Medicaid. Virginia voters elected Democrat Ralph Northam to succeed McAuliffe as governor in January, and Democrats made inroads in the state legislature, too.<\/p>\n<p>An exit poll of Virginia voters on Election Day found that 39 percent of them <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/khn.org\/news\/election-night-surprise-health-care-galvanizes-voters\/\">ranked health care<\/a> as their No. 1 issue. More than three-quarters of the Virginians in this group voted for Democrats.<\/p>\n<p>A <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.urban.org\/research\/publication\/past-due-medical-debt-among-nonelderly-adults-2012-15\">study<\/a> from the Urban Institute may shed some light on why Medicaid eligibility remains a pressing problem: medical debt. While personal debts related to health care are on the decline overall, they remain far higher in states that didn&#8217;t expand Medicaid.<\/p>\n<aside>\n<div><\/div>\n<\/aside>\n<aside>\n<div><\/div>\n<\/aside>\n<p>In some cases, struggles with medical debt can be all-consuming.<\/p>\n<p><!-- END ID=\"RES563030408\" CLASS=\"BUCKETWRAP INTERNALLINK INSETTWOCOLUMN INSET2COL \" --><\/p>\n<p>Geneva Wilson is in her mid-40s and lives outside of Lowry City, Mo. She has a long history of health problems, including a blood disorder, depression and a painful misalignment of the hip joint called hip dysplasia.<\/p>\n<p>She&#8217;s managed to find some peace living in a small cabin in the woods. She keeps chickens, raises rabbits and has a garden. Her long-term goal is to live off her land by selling what she raises at farmers markets.<\/p>\n<p>Her health has made it hard to keep a job and obtain the insurance that typically comes with it. And Missouri&#8217;s stringent Medicaid requirements \u2014 which exclude nondisabled adults without children<strong> \u2014 <\/strong>have kept her from getting public assistance.<\/p>\n<p>Since graduating from college more than 20 years ago, Wilson has mostly had to pay out of pocket for medical care, and that&#8217;s left her with a seemingly endless pile of medical debt.<\/p>\n<p>&#8220;As soon as I get it down a little bit, something happens, and I have to start all over again,&#8221; Wilson says.<\/p>\n<p>Right now her medical debt stands at about $3,000, which she pays down by $50 a month. She desperately needs a hip replacement, but she canceled the surgery because, even with deeply discounted rate from a nearby hospital, she can&#8217;t afford it.<\/p>\n<p>&#8220;Approximately $11,000 is what would come out of my pocket to pay for the hip. That&#8217;s my entire pretax wage from last year,&#8221; Wilson says. &#8220;So it&#8217;s kind of on hold, but I don&#8217;t know if I can survive the year without going ahead and trying to get it done.&#8221;<\/p>\n<p>For many people like Wilson, medical debt can be nearly as problematic as their illness. In 2015, <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.urban.org\/research\/publication\/financial-knowledge-associated-past-due-medical-debt\">30.6 percent of Missouri adults<\/a> ages 18 to 64 had past due medical debt, the seventh-highest rate in the country. Kansas, at 27 percent, had the 15th highest rate. In Maine, which voted to expand Medicaid this week, it was 27.7 percent.<\/p>\n<p>Researchers Aaron Sojourner and Ezra Golbertstein of the University of Minnesota studied financial data from 2012 to 2015 for people who would be eligible for Medicaid where it was expanded.<\/p>\n<p>They found that in states that didn&#8217;t expand, the percentage of low-income, nonelderly adults with unpaid medical bills dropped from 47 to 40 percent within three years.<\/p>\n<p>&#8220;The economy improved and maybe other components of the ACA contributed to a 7 percentage point reduction,&#8221; Sojourner says. &#8220;Where they did expand Medicaid, it fell by almost twice as much.&#8221;<\/p>\n<p>Those states saw an average drop of 13 percentage points, from 43 to 30 percent.<\/p>\n<p>In Kansas, the rate of medical debt for nonelderly adults fell by 4 percentage points to 27 percent. In Missouri, the rate dropped 4 points to 31 percent, according to the Urban Institute. In Maine, it dropped only 1.4 percentage points between 2012 and 2015.<\/p>\n<p>Medicaid, as opposed to private insurance, is the key, says The Urban Institute&#8217;s <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.urban.org\/author\/kyle-j-caswell\">Kyle Caswell<\/a>, because it requires little out-of-pocket costs.<\/p>\n<p>Even if Medicaid patients need lots of care, there aren&#8217;t on the hook for big out-of-pocket costs in the same way someone with private insurance might be.<\/p>\n<p>&#8220;We would certainly expect that their risk to out-of-pocket expenses to be much lower, and ultimately the risk of unpaid bills to ultimately be also lower,&#8221; Caswell says.<\/p>\n<p>But Medicaid&#8217;s debt-reducing advantages over private insurance could disappear under the leadership of the Trump administration.<\/p>\n<p><!-- END ID=\"RES563318390\" CLASS=\"BUCKETWRAP INTERNALLINK INSETTWOCOLUMN INSET2COL \" --><\/p>\n<p>Shortly after Seema Verma was confirmed as the Administrator for the Centers for Medicare &amp; Medicaid Services, she and Tom Price, then head Department of Health and Human Services, sent <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/www.hhs.gov\/sites\/default\/files\/sec-price-admin-verma-ltr.pdf\">a letter<\/a> to the governors outlining their plans for Medicaid.<\/p>\n<p>The letter encouraged states to consider measures that would make their Medicaid programs operate more like commercial health insurance, including introducing premiums and copayments for emergency room visits.<\/p>\n<p>Verma says that by giving recipients more &#8220;skin in the game,&#8221; they will take more responsibility for the cost of care and save the program money.<\/p>\n<p>Republican proposals in Congress to repeal and replace the Affordable Care Act would have eliminated or limited Medicaid expansion. And that would have affected the last few years&#8217; downward trend in medical debt.<\/p>\n<p>&#8220;Anything that reduces access to Medicaid most likely would have the reverse effect of what of we&#8217;re seeing in our paper,&#8221; Caswell says. &#8220;Reduced access to Medicaid would likely increase exposure to medical out-of-pocket spending and ultimately unpaid medical bills.&#8221;<\/p>\n<p>As Geneva Wilson tends to her chickens, she says she tries not to think too much about her medical debt or how she&#8217;ll pay for that hip replacement.<\/p>\n<p>&#8220;It&#8217;s going to the point where, if I were to go shopping at Walmart, I would have to get one of the carts you drive because I can&#8217;t manage,&#8221; she says.<\/p>\n<p>Wilson has already sold her jewelry, some furniture and a wood stove to pay down her debts. Now there&#8217;s not much left to sell except her cabin and her land.<\/p>\n<p>&#8220;Probably the homestead and garden that I want, that I&#8217;ve been wanting and trying to work for, I don&#8217;t think they are a viable dream either,&#8221; Wilson says. &#8220;It&#8217;s hard losing your dreams.&#8221;<\/p>\n<p><em>This story is part of a reporting partnership with NPR, KCUR and <\/em><a class=\"colorbox\" rel=\"nofollow\" href=\"http:\/\/www.kaiserhealthnews.org\/\">Kaiser Health News<\/a>.<em> Alex Smith can be reached on Twitter at <\/em><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/twitter.com\/@AlexSmithKCUR\">@AlexSmithKCUR.<\/a><\/p>\n<p><strong><a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/blockads.fivefilters.org\/\">Let&#8217;s block ads!<\/a><\/strong> <a class=\"colorbox\" rel=\"nofollow\" href=\"https:\/\/blockads.fivefilters.org\/acceptable.html\">(Why?)<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[47],"tags":[],"class_list":["post-13773","post","type-post","status-publish","format-standard","hentry","category-health"],"_links":{"self":[{"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/posts\/13773","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/comments?post=13773"}],"version-history":[{"count":0,"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/posts\/13773\/revisions"}],"wp:attachment":[{"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/media?parent=13773"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/categories?post=13773"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/associatednews.us\/content\/wp-json\/wp\/v2\/tags?post=13773"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}