The statistics are encouraging: In the half a year since the state expanded access to Medicaid, doctors in Louisiana have diagnosed 1,770 cases of high blood pressure, 728 cases of diabetes and more than 90 cases of cancer.
That’s good news. It’s also a potent political weapon.
As the incoming Trump administration and Republican congress ponder the swiftest path to repeal Obamacare, lawmakers who support expanding health coverage are using data to fight back.
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In states across the country, supporters of expanding Medicaid are trumpeting improved screening for chronic diseases and other gains in an effort to preempt GOP efforts to cut the $545 billion program.
Louisiana’s data, which the state displays on a handy online dashboard, prompted a rallying cry this week from Andy Slavitt, acting administrator of the federal Centers for Medicare and Medicaid Services, or CMS. Slavitt jumped on Twitter to highlight the impact of the state’s expansion 5 ½ months ago.
Louisiana expanded Medicaid 5 1/2 m ago.
Since then, 51 breast & 43 colon cancers detected.
All would be repealed. pic.twitter.com/eQjwhifPKN
— Andy Slavitt (@ASlavitt) December 19, 2016
But the fight over Medicaid also centers on cost, and whether taxpayer dollars are being adequately protected.
In a letter to Slavitt this week, Republican lawmakers, including Utah Senator Orrin Hatch, raised concerns about Louisiana’s expansion. They demanded answers within the next month to a flurry of questions, including what CMS is doing to ensure that taxpayers are not still paying Obamacare subsidies for residents who switched to Medicaid coverage. “When do these [individuals’] federal subsidies end?” the letter asked.
A spokesperson for CMS declined to comment on the letter.
Beyond Louisiana, other states are also highlighting their Medicaid expansion data.
In Kentucky, advocates of expanded coverage tout increases in primary care visits, cancer screenings, and other services for nearly 500,000 people who gained coverage. More than 3,700 people in that group received hepatitis C screenings between April and June alone, according to a report by the State Health Access Data Assistance Center, a research institute.
“We were blown away by the data and changes in utilization,” said Emily Beauregard, executive director of Kentucky Voices for Health. “All of these things point to people getting the care that they need earlier and more consistently, and that means we will have better health outcomes down the road.”
Her group is battling a Medicaid waiver proposal, advanced by Governor Matt Bevin, that would require recipients to pay small premiums and hold jobs in order to maintain coverage. Bevin, a Republican, has argued that the changes will encourage people to take responsibility for their own health and keep the program’s spending in check.
In releasing his plan in late August, Bevin said it “will allow us to continue to provide expanded Medicaid coverage, but unlike the current Medicaid expansion under Obamacare, it will do so in a fiscally responsible manner.”
Kentucky’s waiver request is still under review by CMS. Its fate could end up being decided by the consultant who helped draft it, Seema Verma, who was plucked by president-elect Donald Trump to helm CMS after she spent years consulting for states on efforts to curb Medicaid spending.
In Ohio, led by Republican Governor John Kasich, the state Medicaid department also compiles a dashboard that show the state’s uninsured rate has been cut in half since 2012, largely due to Medicaid expansion.
The state conducts a survey every few years to track changes in spending and services used. In 2015, the survey showed that just over half of Medicaid recipients in the state hold jobs, and that far fewer people reported trouble accessing health care services than in 2012, before the state expanded Medicaid.
Kasich, who launched an Office of Health Transformation, has sought to institute cost control measures that emphasize new ways to deliver care. For example, in January, the state is launching a primary care model that rewards providers for lowering costs by improving coordination of patients’ medical services.
In Alaska, meanwhile, the state Department of Health and Social Services operates a Medicaid dashboard that tracks how many people gained coverage and how they’re using the services.
Through the end of November, it highlighted $288 million in additional claims paid for medical services to the expansion population. The biggest increase in spending, about $80 million, has been for inpatient hospital stays, followed by increases in visits to medical clinics and outpatient centers.