For affordable health insurance, some states seek to rely on Medicaid: Shots

These state proposals are often referred to as "Medicaid Purchase Plans" because they typically offer similar benefits to Medicaid, the federal-federal health plan for low-income people.

The proposals for examination vary from state to state. Variables include eligibility criteria, how they could be funded and whether they would be offered to the insurance market of the Affordable Care Act.

And, depending on how they structure their plan, states may need to get approval from the federal government to go forward.

States interested in a participation plan generally plan to take advantage of Medicaid's provider networks and reimbursement rates. These payment rates are generally lower than those of Medicare and commercial plans.

This can help reduce costs, although in some states this also means that the network of doctors will probably not be as extensive as that found in Medicare or in certain commercial regimes.

"Medicare for all will not be legislated in the next few years," said Heather Howard, director of Princeton University's Health Strategy and Value Strategies program, which works in close collaboration with some States. "Meanwhile, states say," What about "Medicaid for more"? ""

In New Mexico, the buyout plan would be similar to the state's Medicaid program. It would be offered off the stock exchange and would not require the federal government's approval to be implemented. The state would provide financial assistance to help low-income people buy.

According to a report commissioned by New Mexico, up to 16,000 people would enroll in a program similar to that originally proposed in state bills and their premiums would be 15 to 28% lower than plans sold on the individual market.

New Mexico Governor Michelle Lujan Grisham is in favor of a Medicaid buyback option. She has no position on the current bill, but she is following it closely, said Nora Sackett, the governor's deputy press secretary.

In addition to the interest of the governor and legislators, other stakeholders have been deeply involved, thereby increasing the chances of success, Howard said.

Lawmakers in Colorado, Oregon, Washington and Minnesota are exploring, among other things, similar options, Howard said. Nevada lawmakers passed a bill last year that would have put in place a Medicaid buyout plan, but the Republican governor vetoed it.

"The proposals take on different flavors in different states" and according to what the authorities are trying to accomplish, she said, it is necessary to increase the number of people insured, to make coverage more affordable or to help states avoid "naked" counties where no market is planned. Free.

The New Mexico bill would target people who are not eligible for Medicaid or Medicare and those who can not qualify for the premium premium of the Affordable Care Act because their incomes are greater than 400% of the federal poverty line (approximately $ 50,000 for one person or $ 103,000 for family of four). The plan would also be available for residents whose immigration status in the United States is undocumented.

And this measure would also help people like Gutierrez, vulnerable to the so-called ACA family problem. The premium of $ 100 a month for her husband's individual coverage is considered affordable by law because it costs less than 9.86% of family income of about $ 46,000 a year. This makes it ineligible for premium subsidies on the exchange, even though the $ 800 premium for both greatly exceeds this percentage of accessibility. Their three children are already covered by Medicaid.

"Right now, I pay for health care, but I can not afford it," says Gutierrez.

The bill would provide state financial assistance, as well as premiums and cost-sharing for people whose income is below 200% of the federal poverty line, or $ 60,340 for a family of five people. The new coverage would come into effect in January 2021.

Gutierrez, whose family lives in Albuquerque, would be eligible for financial assistance to help her join the Medicaid-type scheme, while her husband would stay on his employer's plan. Because their annual income of $ 46,000 represents just over 150% of the federal poverty line, their monthly premium would likely be around $ 160 a month for a full $ 150 deductible plan, according to Manatt Health estimates. who performed the initial analysis of the purchase. Options that were published prior to the introduction of the bills in January.

New Mexico has high levels of poverty and 40% of all residents of New Mexico are already enrolled in the national Medicaid program, compared to about 23% nationwide.

"It's the cornerstone" of our health system, said Colin Baillio, director of policy and communication for Health Action New Mexico, a lobby group. The legislation would use "these levers that allow Medicaid to provide comprehensive coverage and a complete supplier network".

The bills were passed by two legislative committees this month, with instructions for further study, with a view to extending the membership plan to a larger number of groups. They now go to two other legislative committees for review, says Baillio.

And while hospitals and other health care providers are reimbursed at Medicaid rates, which are generally lower than those of commercial plans, to the extent that uninsured people join the new plan, some claimants say they have everything to gain .

"We obviously support anything that broadens the coverage," said Jeff Dye, president of the New Mexico Hospital Association. "It's the question of getting a payment against no payment for the services rendered."

If the Medicaid purchase bill was approved, Blanca and her husband, Hugo, could take out Medicare for the first time since moving to New Mexico 14 years ago. The couple and their eldest son, now 18, are undocumented Mexican immigrants. (NPR does not use their last names to protect the privacy of the family.) Their two youngest children, born in the United States, are enrolled in Medicaid.

Hugo works as a plumber and Blanca studies early childhood development at a community college near their home in Albuquerque. Because they are unauthorized immigrants, they are not allowed to take out health insurance with ACA scholarships, even if they are willing to pay a hefty price.

So, like many people without insurance, they are waiting to be really sick before asking for help. When Blanca developed pneumonia a few years ago, the waiting lists for an appointment in community clinics that would see her without insurance were long. Finally, when she could not breathe comfortably, she went to the emergency department.

"It would give us peace of mind not to have to worry about our health care situation," said Blanca by a translator.

Providing health care to residents without immigration status is "an underlying problem for many states considering a buyout of Medicaid," said Chiquita Brooks-LaSure, chief executive of Manatt Health, co-author of reports in options for New Mexico.

The New Mexico bill would also provide some relief to Leah Steimel's family. Neither she nor her husband benefit from employer – sponsored coverage and, with a family income of about $ 100,000, they are not eligible for a tax credit that would reduce their premiums by account. They now pay more than $ 1,900 a month for a money-based plan with a $ 10,000 deductible to cover their expenses and those of two of their children (the third is over the age of 26).

Buy in a plan similar to Medicaid Steimel, who works as a community health consultant with some of the membership groups, would be tempting. Of course, she says, she wonders if the Medicaid plan would be as easy to use as a standard business plan and would give the family access to as many providers as possible.

"But being able to contribute to something that would even reduce by a third what I'm paying now – I'd like that," she says.

Kaiser Health News is an independent editorial news service that is part of the non-partisan Henry J. Kaiser Family Foundation and is not affiliated with Kaiser Permanente. Michelle Andrews is on Twitter @ mandrews110.