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  • The growth was due primarily to the Affordable Care Act, the national health care reform law under which Massachusetts expanded eligibility for jerseys from china Medicaid. The state also added people to Medicaid temporarily after technical problems with its new state exchange made it impossible to figure out what program a person was eligible for.

    Medicaid spending is important because it makes up around one quarter of the state budget, a percentage that is increasing by the year. High Medicaid costs are also contributing to a deficit in the current, fiscal year 2015, budget.

    "Is it a concern? Yes. Is it something we're not aware of? No," said state Sen. James Welch, a West Springfield Democrat and the Senate Chairman of the Joint Committee on Health Care Financing. "We're aware of it. We're going to try to work towards reining those numbers in."

    For the fiscal year ending June 30, 2014, MassHealth, the state's Medicaid program, had an average caseload of 1.5 million, according to the state's comprehensive annual financial report. The Medicaid caseload grew by 143,000 over the previous year a jump of 10 percent, compared to growth rates of 3 to 5 percent for seven of the last eight years.

    Unsurprisingly, the amount of money spent on Medicaid grew along with caseloads. Total Medicaid expenditures were $14 billion, or 14 percent more than last year. Some of that increase (around $500 million) was due to the reclassification of money that was previously listed elsewhere in the budget. But even accounting for that shift, Medicaid spending grew by $1.18 billion or 9.6 percent compared to 2013.

    While the federal government covers a significant portion of Medicaid costs, the expense paid by state taxpayers was $5.1 billion, up from $4.7 billion in 2013.

    Welch said the state understood when it first started providing universal health care coverage under former Gov. Mitt Romney's 2006 reform that universal coverage comes with increased costs. "It's that balance of universal coverage as opposed to how we pay jerseys form china cheap for it," Welch said.

    There are two major factors that contributed to the 2014 caseload increase. First, under the Affordable Care Act, the state expanded eligibility for MassHealth to anyone earning less than 133 percent of the federal poverty line (around $15,000 a year). Previously, MassHealth was open only to certain groups of people children, the elderly, or those who were disabled or pregnant. The expansion allowed people who previously had other state subsidized coverage, or who were uninsured, to enroll.

    According to Massachusetts' Executive Office of Health and Human Services, the coverage expansion resulted in approximately 190,000 new MassHealth members, of whom 128,000 switched from Commonwealth Care, a state subsidized insurance program for poor residents. The rest were split about evenly between new applicants and those who previously used the state's Health Safety Net, a free care program for poor people who are uninsured or underinsured and ineligible for other state run insurance programs.

    According to the David Kibbe, a spokesman for the Executive Office of Health and Human Services, these new Medicaid patients cost approximately $718 million in fiscal year 2014. Approximately half of that will be reimbursed by the federal government. (The federal government will pay an increasingly larger percentage of costs for these new enrollees over the next few years.)

    Second, the state rolled out a new website in 2013 to enroll people in insurance plans that complied with the Affordable Care Act. But the website was a technological disaster and was unable to determine what insurance program or subsidy a person was eligible for. State officials moved new applicants into MassHealth temporarily but still do not know how many of those people were actually eligible for MassHealth.

    By June 2014, approximately 244,000 people were enrolled in temporary Medicaid, according to the Executive Office of Health and Human Services. This resulted in approximately $140 million of new spending in fiscal year 2014.

    Kibbe said the per patient cost for temporary Medicaid patients was so much lower than for the expansion patients because the enrollment period for many of them was shorter. Also, not all the bills have been submitted yet for the temporary coverage group.

    Outside observers familiar with the system also note that under temporary MassHealth, the state only paid a fee for services that were delivered, while many traditional Medicaid plans included monthly premiums paid by the state.

    The caseload numbers could drop next year, as people are moved off temporary Medicaid. So far, around 130,000 people enrolled in temporary coverage last year have checked their eligibility for new plans using the state's Health Connector website. Of those, slightly more than half are eligible for MassHealth, according to statistics provided by the Health Connector as of Jan. 14.

    Gov. Charlie Baker, a Republican who took office in January, has said he is still trying to get clarity about who was enrolled in temporary Medicaid and what the costs will be.

    Speaking to reporters earlier this month, Baker said that in the mid 1980s, then Senate Ways and Means Committee Chairwoman Patricia McGovern, a Lawrence Democrat, referred to Medicaid as one of the primary problems with the state budget. "This is an issue that's been, over time, the significant issue in the state's budgeting process for as far back as I can remember," Baker said.

    According to the Kaiser Family Foundation, an independent health policy research organization, in 2012, Massachusetts spent the eighth most on Medicaid of any state in the country.

    Supporters of the Affordable Care Act see the growth in Medicaid coverage as positive. "When people get into MassHealth, what it means is they're getting a good health care program that is appointed to keep them healthy, that keeps wholesale nfl jersey them out of emergency rooms and allows them to be more productive employees, allows their families to be healthier," said Brian Rosman, research director of Health Care for All, an affordable health care advocacy group that contracted with the state to help enroll people in coverage.

    Rosman said the Medicaid expansion comes with federal money, and the money goes into the economy through salaries for health care providers.

    Overall, he said, keeping people healthy is good for the economy and for individuals. "Giving people solid, reliable health care enables families to be healthier, be together, provides support for people to go to work, and reduces the strain on emergency rooms by giving people access to primary care," Rosman said.

    But critics of the Affordable Care Act see it differently. Josh Archambault, director of health care policy for the Pioneer Institute, a conservative think thank, pointed out that nearly one quarter of the state's population is on Medicaid.

    "The state has to look itself in the mirror and say do we wholesale jerseys think we're a healthy state if one fourth of our population are on safety net programs?" Archambault said. "We've got a lot of people who get stuck on programs when really we want them to be moving forward, contributing to the economy, supporting families, getting the mental health and financial health benefits of gainful employment."

    Archambault called the rate of Medicaid growth "completely unsustainable." "As you're adding more and more people to the program in a high health care priced state, you're going to be spending lots and lots of money to cover those people, and it will mean less money for education, transportation and any other public priorities you might have," he said.

    The growth in Medicaid also affects private insurers. Eric Linzer, a spokesman for the Massachusetts Association of Health Plans, said six private companies that provide plans to Medicaid patients lost $137 million last year. This was partly due to new high cost therapies, but partly due to the Health Connector problems, which resulted in more people on Medicaid and fewer people on plans that made more money for insurers.

    "Many also operate in the unsubsidized market, and when members didn't materialize and were transferred into temporary coverage, for plans that had been built for a certain membership expectation, that's contributed to their losses," Linzer said.

    Linzer pointed to data from the Massachusetts Center for Health Information and Analysis, which found that between December 2013 and September 2014, enrollment in state subsidized plans grew by 30 percent while enrollment in commercial plans declined by 1.2 percent.