The Affordable Care Act: Caring for Our Most Vulnerable

This post is part of a weekly “Did You Know” blog series that highlights important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health. 

Did you know that the Affordable Care Act contains preventive health provisions that will improve the health of Medicaid recipients and help control costs?

If you’ve been tuning in to our weekly blog series on preventive health measures in the Affordable Care Act, you are well-aware of the many wonderful preventative care provisions that the national health reform law has set in motion. These measures range from community and nationwide preventive and public health programs to timely reforms in the private health insurance market and Medicare that are increasing access to affordable coverage and preventive health care services. What you may not know about are the many important initiatives the ACA is putting to work to prevent chronic diseases among the Medicaid population. These programs are improving the health of vulnerable populations and saving money for the Medicaid program. 

Today, chronic health conditions like Type 2 diabetes, heart disease, stroke, and cancer combine to cost our nation billions of dollars in health care expenditures annually and account for 70 percent of all American deaths each year. Medicaid, the second largest health insurer in the United States, insures one-fifth of Illinois residents. The program covers a population that is disproportionately affected by chronic health conditions, and is certainly picking up its share of the costs for treating and managing preventable chronic diseases. Treatment and management of chronic diseases are crucial to controlling Medicaid costs and health, an important point to remember as budget cuts loom in SpringfieldIt has been proven that for every dollar spent on effective preventive and public health initiatives, $5.60 is saved.

Take a look at just some of the several steps the ACA is taking to cut unnecessary health care costs for the Medicaid program and help low-income individuals and families stay ahead of costly chronic health conditions:

  • The Affordable Care Act is increasing access to preventive health care services for Medicaid recipients at no extra cost to recipients or the states. Access to basic preventive health care services is critical for preventing chronic health conditions, and will save individuals as well as the Medicaid program a lot of money if states choose to provide these services. Starting on January 1, 2013, the federal government will provide states with a one-percent increase in federal matching rates for the specified expanded set of preventive health services.
  • The ACA is increasing access to primary care physicians by boosting Medicaid payments to primary care providers from January 1, 2013, to the end of the 2014, with the increase paid for by the federal government. Payment rates will rise to match Medicare rates during this time period, incentivizing primary care physicians to take on Medicaid patients and, in the end, getting more Medicaid recipients the basic preventive health care they need.
  • Among many other wonderful things the ACA is doing is the effort to help people quit smoking and live healthier lives. The health reform law is requiring states’ Medicaid programs to fully cover counseling and pharmacotherapy services for tobacco cessation for pregnant women. Healthy pregnancies lead to healthy babies and a head start for preventing costly chronic health conditions down the road.
  • The ACA is providing grant money for states that participate in the Medicaid Incentives for Prevention of Chronic Diseases Program, which began in January of 2011. States receiving grants must develop initiatives that provide incentives to Medicaid recipients who participate in a healthy lifestyle program that addresses chronic disease prevention goals. The Medicaid Incentives Program will evaluate the effectiveness of the states’ initiatives and analyze the changes in health risk and outcomes, with the goal of improving health and lowering health care costs.
  • Finally, effective January 1, 2014, the Affordable Care Act is expanding the Medicaid program to cover an additional 16 million people (700,000 of them in Illinois) who are uninsured today by changing the standards for eligibility to include almost all persons living at or below 138 percent of the federal poverty level. The states will not have to foot any part of the initial bill for the “newly eligible” Medicaid population; the federal government is covering 100 percent of the cost until 2017; after that, federal payments will slowly decrease to 90% of the cost by 2022. Recent research shows that newly covered individuals seek cost-effective primary care more often, use emergency room and in-hospital admissions less, and, in effect, cut health care costs for everyone.

By putting effective preventive health initiatives to work for the Medicaid program, the Affordable Care Act is making the second largest health insurer in the United States more cost-effective, saving taxpayers money, and improving the health and well-being of millions of Medicaid recipients. For more on what the ACA is doing for preventive health, check out the Shriver Center’s “Did You Know” blog series online, or visit healthcare.gov.

This blog post was coauthored by Rachel Gielau.

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