A report by the Center for Economic Policy and Research (CEPR) advocates allowing Medicare and Medicaid beneficiaries to move to other countries and buy into their health insurance systems using U.S. vouchers.  The CEPR says the system would reduce U.S. health care costs while improving quality.  Under the proposed system, the government and the beneficiaries would split the savings obtained from using the non-U.S. systems, which spend, on average, nearly half of the $6,714 that the U.S. health care system spends per-person on health care and achieve longer life expectancies.  In addition, the program would give the provider country a premium above their costs to ensure their participation in the program.  The report estimates the cost savings of such a program based on several projected levels of participation.

From the introduction:

There are large differences between the per-person cost of providing health care in the United States and the per-person cost in other countries with comparable health care outcomes. In 2006, the per-person cost of health care in the United States was $6,714, while the average cost in the 26 countries with longer life expectancies was $2,964. This gap suggests the potential for substantial gains from trade.

This paper outlines a mechanism for taking advantage of these potential gains from trade: a globalization of the Medicare and Medicaid programs. Since most of the beneficiaries of Medicare are retirees, as are a substantial portion of the beneficiaries of Medicaid, they need not live near a workplace. Many beneficiaries have family or other ties to other countries. The globalization mechanism proposed in this paper would allow beneficiaries of these programs to have a voucher that would allow them to move to other countries and buy into their health care systems, with the government and the beneficiaries splitting the gains. To provide an inducement for other countries to participate, they would receive a premium (e.g. 10 percent) above their costs to ensure that they benefit from this process as well.

Center for Economic Policy and Research. (2009). Free trade in health care: the gains from globalized Medicare and Medicaid. Dean Baker and Hye Jin Rho.

Full report: http://www.cepr.net/documents/publications/free-trade-hc-2009-09.pdf

This Migration Policy Institute (MPI) report finds that current health care reform proposals do little to help immigrants, including legal permanent residents.  MPI finds that 4.2 million of the 12 million legal immigrants in the U.S. are currently uninsured and notes that many are temporarily barred from state Medicaid programs because of a 1996 law requiring that legal aliens wait five years from the date they obtain their green card before becoming eligible for Medicaid.  The report finds that maintaining that restriction and applying it to the government health insurance subsidies for individuals earning up to 400 percent of the federal poverty level (FPL) will limit health insurance access for over 1 million legal immigrants.  In addition, the report examines the cost implications of limiting health insurance access for both legal and illegal immigrants under various health reform proposals. 

Full Report: http://www.migrationpolicy.org/pubs/healthcare-Oct09.pdf 

Migration Policy Institute. (2009). Immigrants and health care reform what's really at stake? Randy Capps, Marc R. Rosenblum, Michael Fix.

This report released October 6, 2009 by the National Center for Assisted Living (NCAL) found that Medicaid spending on home- and community-based services (HCBS) increased 81.5 percent from FY2001 to FY2007, while nursing home spending grew 9.8 percent over the same period.  The report found that, from 2001 to 2007, Medicaid nursing home spending went from $42.7 billion to $46.9 billion while HCBS spending increased from $9.2 billion to $16.7 billion.  In addition, the number of people receiving Medicaid services in licensed assisted living settings increased 44 percent from 2002 to 2009 and HCBS Medicaid waivers now cover services in residential settings in 37 states while an additional 13 states provide coverage directly though the state Medicaid plan. 

From the report's major findings:

Full Report: http://www.ahcancal.org/ncal/resources/Documents/MedicaidAssistedLivingReport.pdf 

National Center for Assisted Living. (2009). State Medicaid reimbursement policies and practices in assisted living. Robert L. Mollica

A new fact sheet published by the UCLA Center for Health Policy Research finds that 93 percent of Californians under 65 would have access to health coverage if Congress passes a national health reform bill.  Four million state residents would be eligible for Medi-Cal or would qualify for subsidies to purchase private insurance.

From the document:

If leading proposals in Congress for national health care reform are enacted, most of California’s 6.4 million nonelderly adults and children who were uninsured for all or part of the year in 2007 would directly benefit. The three major proposals in both the House and Senate all would make two key changes: 1) they will expand Medicaid eligibility to include qualified uninsured adults and children with household incomes up to 133% of the Federal Poverty Level (FPL); and 2) they will provide public subsidies to enable qualified uninsured adults and children with household incomes from 134 – 400% FPL to purchase insurance.1 An estimated four million Californians would be newly eligible either for public health insurance (in Medi-Cal, California’s Medicaid program) or for public subsidies to purchase private coverage.

UCLA Center for Health Policy Research. (2009). National Health Care Reform Will Help Four Million Uninsured Adults and Children in California. Lavarreda, Shana & Brown, E. Richard.

Fact sheet: http://www.healthpolicy.ucla.edu/pubs/files/HCR_FS_10-09.pdf

This study conducted by the California Endowment and the California HealthCare Foundation found that the new federal requirement to conduct citizenship checks on all Medicaid applicants has added considerable costs to all 58 California counties.  The study also found that the citizenship checks created new barriers to care for qualified applicants and yielded few cases of fraud.

From the report:

The federal statute and implementing regulations promulgated by the Centers for Medicare and Medicaid Services (CMS) are very specific and define a limited and prescriptive list of documentation that can be used to satisfy the DRA requirement, including a hierarchy of acceptable documentation. When acceptable documentation is not immediately available, federal guidance directs the states to provide a “reasonable opportunity period” (ROP) for applicants and enrollees to present the necessary documentation. California’s Department of Health Care Services (DHCS) moved in a deliberative manner to implement the new requirement. Acting specifically to minimize any potential negative impacts of the DRA, DHCS completed several data matches of current Medi-Cal eligibility files and California Vital Statistics data prior to issuing guidance to the counties. DHCS also updated the Medi-Cal Eligibility Data System (MEDS) to allow county eligibility workers to request birth matches for Medi-Cal clients. DHCS issued All County Welfare Directors Letter (ACWDL) Number 07-12 on June 4, 2007 directing the counties to begin to operationalize the DRA requirement. However, even with the measured pace of implementation in California, concern remained about the potential negative impacts of the DRA requirement on Medi-Cal clients and California’s counties.

The California Endowment. (2009). Impact of the DRA citizenship and identity documentation requirement on Medi-Cal: findings from site visits to six counties. Davis, Caroline, Brown, Gretchen, Smith, Vernon, Ellis, Eileen & Hughes, Dana.

Full report: http://www.calendow.org/uploadedFiles/Publications/Policy/General/CA_DRA_report_October_2009.pdf

According to SK&A Healthcare Information Solutions’ (SK&A) Physician Office Acceptance of Government Insurance Programs Report, 83 percent of physicians’ offices accept Medicare and 65 percent accept Medicaid.  In addition, this report found that Medicare and Medicaid acceptance varied by size, ownership, location, and specialty of physicians’ practices.  Larger practices are more likely to accept Medicare patients than smaller practices, while hospital-owned practices are more likely to accept Medicaid than non-hospital-owned practices.

Press release: http://www.pr.com/press-release/188966