Monday, December 08, 2014

Is Medicaid expansion reducing SSI claims? If so, an uninsured diabetic in Tennessee called it

There is some evidence that the ACA's Medicaid expansion may be reducing claims for Supplemental Security Income (SSI). While such claims are dropping across the US as employment picks up, they're dropping somewhat faster in states that opted in to the ACA Medicaid expansion Modern Healthcare's Virgil Dickson reports:
The number of Americans applying for Supplemental Security Income benefits dropped in the first six months of this year compared to the same period last year, and experts are debating whether the decline is partly related to the healthcare reform law's Medicaid expansion to low-income adults.

A total of 1,189,567 SSI disability claims—mostly related to physical or mental disability— were filed in the first six months of 2014, compared with 1,330,169 during the same period last year, a drop of 10.6%, according to data obtained by Modern Healthcare from the Social Security Administration through a Freedom of Information Act request. The total decline in SSI claims in states that expanded Medicaid in the first six months of 2014 was 11.2%, compared with 10.0% in non-expansion states.
Back in June 2012, an uninsured diabetic waiting in line for treatment at a Remote Area Medical clinic in rural Tennessee forecast such a drop to New Republic reporter Alec MacGillis:

..it it was hard to find visitors to the clinic who would not benefit directly from the law. Barbara Hickey, 54, is a diabetic who lost her insurance five years ago when her husband was injured at his job making fiberglass pipes. She gets discounted diabetic medication from a charity, but came to the clinic to ask a doctor about blood in her urine.

Under the law, she would qualify for Medicaid. Her eyebrows shot up as the law was described to her. "If they put that law into effect, a lot of people won't need disability," she said. "A lot of people go onto disability because they can't afford health insurance."
Some of the health policy people Dickson (and colleagues Rachel Landen and Paul Demko) spoke to have noticed as much:
“Prior to the Medicaid expansion, if you were a poor individual with serious health issues, if you didn't have children, SSI may well have been the only path to health insurance,” said Elizabeth Lower-Basch, a policy coordinator at the Center for Law and Social Policy, a liberal think tank based in Washington, D.C. “At least some people are likely to have applied for SSI more for the health insurance coverage than for the income. With expanded Medicaid eligibility, they wouldn't need to do so.”
That said, the evidence thus far is nascent and modest. Dickson closes with a fair assessment:
Some experts cautioned that the drop in SSI claims would have to continue for several years at a greater pace in expansion states than non-expansion states to demonstrate that Medicaid expansion was the likely cause of the decline.

Arkansas State Sen. Jonathan Dismang, a Republican who supported Medicaid expansion, said he and his colleagues had hoped that expanding Medicaid would reduce the number of people in the SSI program. “It's too early to say with any certainty that that's the case,” he said. “I think that there's an indication that there has been an impact.” 

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