Under President Obama’s landmark health reform law, states will institute — either on their own or with the help of the federal government — insurance exchanges that will act as virtual marketplaces where Americans can purchase health coverage. Plans on these exchanges must include benefits across ten broad “essential health benefit” categories, including preventative care, maternity care services, and prescription drug coverage. But experts are now saying that states should go beyond the federal standard and designate vision care as an essential health benefit, too.

According to Kaiser Health News, while states mandate vision benefits for children, adults are largely left to fend for themselves, perpetuating a system in which otherwise insured adults decide to forgo vision care rather than pay for crucial treatments out-of-pocket:

[R]esearchers found that more than 40 percent of people in their study lacked vision insurance. They also looked at a subgroup of about 12 percent of people in the study who reporting having glaucoma, macular degeneration, or cataracts — the three leading causes of vision loss in the U.S. About 40 percent of that group also did not have vision insurance. Yet nearly 90 percent of both groups had health insurance.

Dr. Sudha Xirasagar, who oversaw the study, said she was particularly surprised to see such a high number of people without vision insurance, particularly those with serious eye conditions.

“Lack of vision insurance impedes eye care,” Xirasagar said, which “may irrevocably affect vision.”

The researchers also found that people with vision insurance were more likely to have seen an eye doctor within the past year and were less likely to report having difficulty seeing and reading.

“You would think that people who have glaucoma and macular degeneration should be worried about their eyes and should be going and getting [care] regardless of whether they have vision insurance or not. But they don’t, which is a bad thing,” said Xirasagar.

The American Academy of Ophthamology estimates that by age 80, more than half of all Americans have cataracts, accounting for $6.8 billion in annual health spending. And as lawmakers in Washington consider raising the Medicare eligibility age to 67, more and more seniors may have to rely on Obamacare’s insurance exchanges for their care — furthering the case for vision benefits as an essential need.

A new study from the Government Accountability Office (GAO) finds that since 2008, state efforts to reform Medicaid and make the low-income safety net program more efficient — likely spurred by provisions in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) and Obamacare — have resulted in lower application processing times and high beneficiary coverage satisfaction comparable to private health insurance.

The study also found that the main hurdle to ensuring beneficiary satisfaction was the shortage of caregivers who accept Medicaid patients, mainly due to low payment rates for the doctors who take on Medicaid patients. As the GAO summarizes:

States reported making numerous changes to provider payments, provider taxes, and beneficiary services since 2008. While more states reported provider-rate and supplemental payment increases each year from 2008 through 2011, the number reporting payment reductions and increased provider taxes also grew. More states reported increasing services than limiting them.

Over two-thirds of states reported challenges to ensuring enough Medicaid providers to serve beneficiaries — including dental and specialty care providers. States cited Medicaid payment rates and a general shortage of providers as adding to the challenge. To attract new providers, over half the states reported simplifying administrative requirements or increasing payment rates.

In calendar years 2008 and 2009, less than 4 percent of beneficiaries who had Medicaid coverage for a full year reported difficulty obtaining medical care, which was similar to individuals with full-year private insurance; however, more Medicaid beneficiaries reported difficulty obtaining dental care than those with private insurance.

CHIPRA and Obamacare both expand the Medicaid program by vastly increasing the program’s funding, encouraging more aggressive enrollment efforts in the states, and rewarding states that successfully expand their coverage pool by insuring the poorest Americans.

The fact that Medicaid beneficiaries are self-reporting satisfaction with their coverage at the same rates as private insurance subscribers suggests that the program is working well — at least in states where it is well-funded. Safety net programs tend to enjoy high levels of satisfaction in general, with Medicare beating out private insurance with a 92 percent approval rating. Medicaid could be on the road to that same level of success if it’s adequately funded. But that would likely happen only if Republican governors decide to accept the federal government’s extremely generous funding to implement Obamacare’s Medicaid expansion.

Last week, Republicans on the House Energy and Commerce Committee voted to slash $400 million from a program that would offer states performance bonuses if they enrolled more children in CHIP or Medicaid. Twenty-three states have already taken advantage of those bonuses, including 16 that increased their enrollment by more than 10 percent.

A new analysis released today looks at how those bonuses have increased enrollment nationwide. The study from the Georgetown University Center for Children and Families examined the 23 states that received performance bonuses for enrolling more children, and found that this program has already had better-than-expected effects:

Data on the bonuses show that in the 23 states that received bonuses in FY 2011, an additional 1.1 million kids were enrolled above expected levels. The most (123,000) can be found in the state of Ohio. While we can’t say that the bonuses fully explain this jump in enrollment, it would certainly be fair to say that they get some of the credit for supporting states in reaching these kids.

As we’ve seen over the years, Medicaid and CHIP have been responsible for driving the uninsured rate of children down to record lows. These bonuses have been an important incentive in making this progress and dismantling them threatens to undercut the great success we’ve seen in Medicaid and CHIP.

Over 12 million children were enrolled in the program in all 23 states combined. Altogether, those states boosted their enrollment numbers 10 percent higher than the expected level, and earned close to $300 million in bonus money for doing so. Thanks in large part to CHIP, the rate of uninsured children is at the lowest-recorded level ever.

As ThinkProgress reported yesterday, the cuts are not expected to pass the Senate this time around, but there is worry among children’s health advocates that they may be reintroduced at a later date. President Obama’s recent budget proposal did call for a change in the federal matching rates for CHIP beginning in 2017.

-Zachary Bernstein

Despite the fact that many government health programs can save money and lives, Republicans are still trying to chip away at the safety net for the least fortunate. Recently, they turned to incentives designed to help children gain access to better health care.

As part of an effort to reduce health spending by $115 billion, Republicans on the House Energy and Commerce Committee voted last week to cut $400 million from a program designed to make it easier for children in lower-income families to gain insurance through Medicaid or the Children’s Health Insurance Program (CHIP) and offer bonuses to states that see increases. According to Politico, 23 states have received bonus money for enrolling more children, with 16 of those boosting enrollment by more than 10 percent. While the proposal’s immediate future is dim, opponents say there is a chance it could resurface later on:

Although the Senate is unlikely to pick up this measure, [Executive Director of Families USA Ron] Pollack said he’s concerned it could reappear when Congress returns after the elections with a full plate of legislation in need of offsets.

“When you start with the House-passed budget and efforts like this, while it’s clear that they’re not going to become law, it’s just part of an opening bell about how the Republicans in the House want to handle a larger effort that will take place some time after the elections,” he said.

The lead sponsor of this bill, Rep. Joe Barton (R-TX), claimed weakening the eligibility requirements to boost coverage encouraged more people to try and game the system. But as Politico noted, the study he cited to back up his claim did not include any data specific to the bonus program Republicans are seeking to cut.

Here is what CHIP actually has done: It has helped cut the national rate of uninsured children to the lowest recorded level ever, keeping millions from losing all health coverage, and pushing long-term health costs lower. The program Republicans want to cut, meanwhile, paid out close to $300 million in bonuses last year alone and has already encouraged states to streamline their enrollment processes, eliminating bureaucratic waste.

The Republican budget presented by Rep. Paul Ryan (R-WI) would make dramatic cuts to child care funding and nutrition programs, and leave millions uninsured or underinsured.

-Zachary Bernstein

Our guest bloggers are Katy Womble and Kasey Mckeral, interns at the Center for American Progress.

Yesterday, the Kaiser Commission on Medicaid and the Uninsured released their annual report outlining trends in Medicaid and Children’s Health Insurance Program (CHIP) eligibility, enrollment, renewal, and cost-sharing policies in all fifty states. As families continue to struggle in a weak economy, Medicaid and CHIP remain essential sources of healthcare coverage for children.

The report demonstrates that the number of uninsured children dropped to 8 percent in 2010 (the lowest uninsured rate for children since the federal government began tracking this statistic in 1987), even as a slow economic recovery meant lower access to employer-based coverage. The ACA requirement for states to maintain eligibility levels and enrollment procedures was essential in Medicaid and CHIP coverage levels remaining stable. States also relied on the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) to adopt new technologies that streamlined the enrollment process and increased workloads the accompanied higher enrollments. Using the bonuses included in CHIRA, states adopted tools like express lane eligibility, SSA Data Match to verify citizenship, and simplified renewal options.

As Medicaid programs expand coverage, however, communities must find new ways to reach out to eligible people and to deal with the increasing number, and cost, of Medicaid participants. Partnerships between state and community-based organizations have helped Massachusetts achieve a 99.5% coverage rate for eligible children. Bottom-up approaches like recruitment tables at churches, malls, schools, and ads in local ethnic media sources have helped states like Massachusetts push enrollment rates to the highest levels in the nation. Community outreach strategies have been particularly valuable in Massachusetts, precisely because the state has expanded the income eligibility threshold to allow families to enroll in Medicaid even if they do not fall below the federal poverty line ($18,530 per year).

Overall, states have expanded eligibility requirements and enrollment, but more work needs to be done on improving retention and utilization of Medicaid and CHIP services. Income disparities still exist between states when it comes to the threshold for providing Medicaid and CHIP coverage. Seventeen states only authorize Medicaid eligibility if a family of three has an income of $9,265 or below. In contrast, the CHIP programs in states like Massachusetts have a lower threshold for eligibility ($37,060 per year), helping to protect low and moderate income children even during a recession. Beginning in 2014, the Affordable Care Act will address these disparities by harmonizing the income threshold at 138 percent of the federal poverty level. In the future, we expect to see administrative and cultural changes that will strengthen coverage and prepare communities for anticipated reforms.