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The reduction in Medicaid funding signed into law last July will have significant impacts on the state and local levels. KFF Health News reported on how California, for example, could lose $30 billion each year in Medi-Cal funding, which could account for 15% of the state program's budget. On a local level, that means that millions of people will likely be losing health insurance ("estimated 10 million"). One researcher noted: "This is the moment where a lot of hard decisions have to be made about who gets care and who doesn't... The number of people who are going to lose coverage is large, and a lot of the systems that were in place to provide care to those individuals have either gone away or diminished."

The expansion of Medicaid coverage as part of the Affordable Care Act made sense in many ways. When states and counties come to rely on that funding, and that funding is abruptly reduced, it is no surprise that the change can be a devastating shock to the system.

The budget passed in July of last year cut Medicaid funding by about $1 trillion over ten years. Large numbers can be abstract, but KFF Health News reported on how the looming cuts (along with shortfalls in state budgets) are affecting behavioral health therapists. In North Carolina, for example, therapists treating autism expect a 10% rate cut, while in Nebraska, the anticipated rate cuts might be more than 30%. Funding for autistic patients can also limit the covered number of hours of treatment in a week. The article profiled some very real concerns from families. Interestingly, leadership of one organization of behavioral health therapists seemed to think that the rate cuts were appropriate. The CEO of that organization believes that the treatment plan should vary more widely, based on patient needs.

From a policy perspective, the right level of reimbursement can be difficult to figure out. Setting the rate too high can lead to inefficiencies and diminishing gains, and setting the rate too low can leave problems untreated (potentially incurring higher longer-term costs). What makes this decision especially difficult is that the professionals who are likely in the best position to assess the efficacy of treatments are the therapists themselves, creating a conflict of interest. Nevertheless, when patients who need treatment are unable to get treatment, supply is likely too low, meaning that the reimbursement rate is inadequate.

We hope last year ended well for you all, and that this year will be even better.

Happy New Year!

We wish you a joyous season of glad tidings.

Merry Christmas!

The previous presidential administration mandated that credit agencies could not include medical debt on consumer credit reports. KFF Health News reports, however, that the current administration "chose not to defend" such regulations. Furthermore, the Consumer Financial Protection Bureau under the current administration has "said that states do not have the authority to regulate consumer credit reports." Some states have passed legislation in the spirit of the earlier regulation, even though the legality of such legislation is being considered.

Given the vagaries of healthcare pricing and various seemingly arbitrary denials from insurance companies, protection from medical debt seems like it would garner much sympathy from the public. If enough people are affected, perhaps there will be momentum to codify such protections into federal law, similar to the legislation against surprise medical bills.