Quantifying the Impact of Medicaid Expansion

How did Medicaid expansion under the Affordable Care Act impact health insurance coverage, cost and mental health? That is the question asked by Andreyeva, Rochford and Marthey (2025). They use 2011-2019 data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine outcomes for Americans aged 26–54 with at least one child living in the…

Why don’t physicians accept Medicaid patients?

One reason is that reimbursement rates for Medicaid are lower than for Medicare or commercial insurance. Another (often overlooked) factor, however, is physician’s risk of payment denials and the administrative hassle they face trying to get reimbursed by Medicaid. A paper by Dunn et al. (2024)–cleverly named “A Denial a Day Keeps the Doctor Away“–shows…

Medicaid Prescription Drug Rebate program: A review

A helpful reminder of what rebates are for drugs covered under State Medicaid Agencies. ICER reports in their California, based on a helpful summary from the Kaiser Family Foundation: For brand name drugs, the [Medicaid] rebate is 23.1% of Average Manufacturer Price (AMP) or the difference between AMP and “best price,” whichever is greater. Certain…

Do narrow networks save money?

According to a recent paper by Wallace (2023), the answer is ‘yes’, but it does so in a highly inefficient manner. Using 2008-2012 Medicaid data from the New York State Department of Health, the author find that: Leveraging the random assignment of over 50,000 Medicaid enrollees in New York, I present causal evidence that narrower…

Factors impacting state variation in health care spending

A Health Affairs Forefront article by Johnson and Dieleman (2022) published last week using the Centers for Medicare and Medicaid Services’ (CMS’s) State Health Expenditure Accounts (SHEA) data. A previous study looked at these data through 2014, but the recent publication updates this analysis through 2019. The authors first use a age- and sex-standardized health…

Who pays more for hospital and physician services: commercial payers, Medicare or Medicaid? And how much more?

Many people might know that generally the answer is commercial health plans have the most generous reimbursement compared to government plans. However, a key question is how much more do they pay? Commercial vs. Medicare rates A January 2022 report by the Congressional Budget Office finds that commercial payers reimburse hospitals at 223% of Medicare…