The Department of Health and Human Services has announced another $100 million in new grants designed to establish new community-based health-care centers and more than $350 million in new grants to fund health-care innovation. That spending is aimed at developing a new health-care paradigm, and it gives clues to where health-care thought-leaders are heading.
But this $100 million is just the tip of the iceberg! Funding has been going on since 2010 and many states are gratefully taking advantage of the grants. According to Tracking ACA Implementation in California Version 5: January 2014 (http://www.calhospital.org/sites/main/files/file-attachments/aca_funding_fact_sheet.pdf), California has already won the prize having received over a billion dollars in grants. One billion, 143 million, while New York has received 899 million, Michigan 815 million, Texas 743 million and Nevada 62 million.
Under an ACA program called the State Innovation Models Initiative, Arkansas, Maine, Massachusetts, Minnesota, Oregon and Vermont this year began testing new health care models. Another 19 states are in various stages of developing similar experiments.
Out of the $1.8 trillion the ACA is projected to cost over the next decade, $10 billion is dedicated to innovation programs. A unit of the U.S. Department of Health and Human Services known as the Center for Medicare and Medicaid Innovation reviews applications and approves the grants.
"The idea is to take governors up on their claim that states are the laboratories of democracy where meaningful innovations can occur," said Susan Dentzer of the Robert Wood Johnson Foundation, a nonprofit group that promotes improvements in the U.S. health-care system.
Colorado, New York, and Washington are next in line to test their cost-containment models. California, Connecticut, Delaware, Hawaii, Idaho, Illinois, Iowa, Maryland, Michigan, New Hampshire, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, and Utah are already funded and using federal money to develop their models.
A common theme is connecting more people to "patient-centered medical homes" where "care coordinators", i.e. nurse Practitioners and Physician's Assistants, ensure they receive cancer screenings and other preventive care. For those with chronic illnesses such as diabetes, high blood pressure, C.O.P.D., asthma and heart disease, the goal is to avoid expensive hospitalizations by managing their conditions with medicine and lifestyle changes. Programs for expectant mothers are also being created to help prevent premature births.
The re-election of Republican governors in Florida, Georgia, Wisconsin, Maine, and Kansas dims the chances of Medicaid expansion in those states to the detriment of their citizens. They won't be applying for grants so they won't be getting any money.
Additionally, the first year of the Affordable Care Act in Mississippi was a disaster. In a state stricken by diabetes, heart disease, obesity, and the highest infant-mortality rate in the nation, President Barack Obama's landmark health-care law has barely registered. The country's poorest and most segregated state is trapped in a severe and intractable crisis.
Of the nearly 300,000 people who could have bought coverage, just 61,494, some 20 percent, did. Mississippi is the only state in the union where the percentage of uninsured residents has gone up, not down, according to one analysis.
CALIFORNIA'S CONSUMER ADVOCATES ENSURE THAT OBAMACARE SUCCEEDS
Since the passage of the Affordable Care Act in 2010, California has expanded health insurance coverage more quickly than any other state. By early 2014, the state had already enrolled 500,000 people in private health-insurance plans through its exchange marketplace called Covered California. During the same period, they enrolled 1.2 million low-income people in its expanded public Medicaid program known as Medi-Cal. The achievement is all the more impressive since at the beginning a fifth of all Californians were uninsured.
Recruitment was/is funded by $37 million in state grants. Four dozen diverse groups from around California -- including labor unions, civil-rights advocates, medical clinics, and the Los Angeles Unified School District -- launched education programs promoting Obamacare. The program will continue for the second round of sign-ups in January.
The 48 recipients were selected from about 200 that applied for the grants, chosen for their access and ability to reach the estimated 5.3 million Californians in underserved communities who will be eligible for the subsidized or guaranteed health coverage.
"These organizations are well-established and well-known and trusted in their communities," said Larry Hicks, a spokesman for Covered California, the state agency established to oversee a marketplace of insurance carriers. "They'll take a more personal approach in explaining the programs and offerings through our health-insurance exchange."