Medicaid Expansion

Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.

Back on February 28th I noted that ACA Medicaid expansion enrollment across three states (Michigan, Louisiana and Pennsylvania) had grown by about 35,000 people since mid-January, to 667K, 406K and 716K people respectively.

Today, a month later, I decided to take another look at all three states, along with Minnesota (which I forgot to check last month). Sure enough, enrollment has continued to grow in all four, albeit at a slower pace:

Over the past month or so, I've been tallying up the number of people who would lose their healthcare coverage if and when the GOP actually does proceed with repealing the Affordable Care Act, breaking the totals out by both County and Congressional District in every state.

While this project has received high praise as a useful resource, one problem with it is that the numbers aren't static--between the high churn rate of the individual market and Medicaid, as well as the fact there's no limited enrollment period for Medicaid (you can sign up year-round), the enrollment figures are constantly changing.

Case in point: As of the beginning of January, roughly 640,000 Michiganders were enrolled in "Healthy Michigan", our name for ACA Medicaid expansion. By the end of January, that number had increased to just over 646,000.

 

For the most part, Republican Michigan Governor Rick Snyder has taken a fairly hands-off approach when it comes to both the Affordable Care Act and Donald Trump. He pushed for both Medicaid expansion and a state-based ACA exchange, but while he managed to get the former through the GOP-controlled state legislature (albeit 3 months late and with a few conservative trimmings), he failed on the latter front, and pretty much shrugged it off after that. Since then, Michigan's implementation of ACA Medicaid expansion has quietly been pretty damned successful, with 646,000 Michiganders (strike that...it's now up to 666,000!) enrolled in the program...over 6.5% of the entire state's population. Beyond that, however, Snyder has been fairly quiet about the ACA overall to my knowledge.

The last official ACA Medicaid expansion enrollment number I have recorded for Indiana (via their modified "Healthy Indiana 2.0" program) was 290,000 people way back in July 2015. At the time, the maximum potential HIP 2.0 enrollment total was 680,000 Hoosiers, made up of 350,000 newly covered plus another 330,000 being transferred over from the HIP 1.0 program.

This NPR article from a couple of weeks ago states that as of January, "the Healthy Indiana Plan that he established in 2015 as the state's governor has brought Medicaid coverage to more than 350,000 people." However, that number is a bit confusing given that they were also supposedly transferring the other 330K over from the other program as well. I'm not sure if 350K refers to total HIP 2.0 enrollment or only those who were previously uninsured.

I haven't posted an update on Pennsylvania's implementation of the ACA's Medicaid Expansion provision since last May, when it stood at around 625,000 enrollees.

Just moments ago, PA Governor Tom Wolf announced that enrollment has now broken the 700,000 milestone:

Over 700,000 Additional Pennsylvanians Enrolled in Governor Wolf’s Medicaid Expansion Plan
February 02, 2017

Harrisburg, PA – In February of 2015, Governor Wolf expanded Medicaid to ensure that Pennsylvanians can receive affordable, straightforward, accessible healthcare without unnecessary delays and confusion. Today, Governor Wolf announced that over 700,000 Pennsylvanians have enrolled in HealthChoices, Pennsylvania’s mandatory managed care Medicaid program, since expansion occurred two years ago. U.S. Census data shows that the commonwealth’s uninsured rate has dropped from 10.2 percent in 2010 to 6.4 percent in 2015.

OK, this appears to be quickly turning into my next project thing. The methodology here is pretty much the same as the other states; the only major difference is that while I do know the total Medicaid enrollment for each county (as of December 2016), I don't have that broken out between traditional and expanded Medicaid. Fortunately, I have a hard state-wide number for that: Around 398,000, or roughly 20.8% of the state-wide total. I've therefore multiplied each county number by 20.8% to get a rough estimate of the ACA expansion tally for each.

Like Texas, I'm also no longer expecting Arizona to beat last year's Open Enrollment total by much. Assuming 209K QHP selections, there should be around 125K indy market enrollees and 399K Medicaid expansion enrollees who'll be in a world of hurt post-repeal, or roughly 524,000 altogether.

(sigh) OK, after doing this for Michigan earlier today, I said that I wasn't gonna do this for every state, and I'm not...but the irony is that the 19 non-expansion states are actually easier to compile this data for than the expansion states...because you can't rip away healthcare from someone you never provided it to in the first place. Anyway, someone requested that I do a county-level estimate of how many people would likely lose their healthcare coverage in Texas under a full repeal of the Affordable Care Act, so here it is.

Regular readers (and Twitter followers) know that for the past month I've been heavily pushing my state-by-state analysis projecting how many people I expect to lose their healthcare coverage if/when the Republican-held Congress follows through on their promise to repeal the Affordable Care Act. As noted in that post and the various links within it, part of the projection is very specific and confirmed (ie, the exact number of Medicaid expansion enrollees), while the rest is more speculative. For one thing, I don't know exactly how many people will have enrolled in ACA exchange plans, because we're still in the middle of the open enrollment period; even then, the percentage of those enrollees who will be receiving APTC assistance is still unknown as well...and even then, not all of those folks will be receiving substantial subsidy assistance which would make or break their ability to keep their policy.

Every month I post an entry about the official CMS Medicaid enrollment report, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees. I wrote about the August 2016 report back on 11/20, and normally would be writing about the September report today. Instead, however, I'm skipping right past September, because the preliminary report for October was just released today:

As anyone who's visited the site the past few days knows, I've spent countless hours digging up data to find out exactly how many people are enrolled in Medicaid/CHIP specifically due to the ACA's expansion provision. This is much more difficult than you'd think for a variety of reasons. For one thing, each state seems to have different methodology for how they track and report Medicaid enrollees (some weekly, some monthly, some quarterly, etc). For another, there's a wide variety of eligibility thresholds under pre-ACA Medicaid for different groups of residents in each state (pregnant women, infants, children, parents, etc), and since the funding mechanism varies depending on whether the enrollee qualifies for "normal" Medicaid or "ACA expansion" Medicaid, categorization can be tricky. Finally, due to the churn factor (people moving up and down the income scale as well as gaining or losing job-based or other forms of coverage), the numbers can jump around from month to month or even week to week.

Earlier today I posted fully broken-down estimates of just how many people would be directly impacted by a full & repeal of the Affordable Care Act this spring, assuming that the repeal took immediate effect and there was no replacement plan in place for the various provisions of the law.

The largest single category of enrollees in my estimates are those enrolled in Medicaid/CHIP due specifically to the ACA's Medicaid expansion provision. I estimated this to be roughly 11.3 million people nationally.

However, I was just informed of a new report released by the Foundation for Government Accountability, an anti-ACA think tank, which has compiled their own estimates of ACA Medicaid expansion enrollment on a state-by-state level. Here's what they've come up with:

From Phil Galewitz Via NPR:

In Depressed Rural Kentucky, Worries Mount Over Medicaid Cutbacks

For Freida Lockaby, an unemployed 56-year-old woman who lives with her dog in an aging mobile home in Manchester, Ky., one of America's poorest places, the Affordable Care Act was life altering.

The law allowed Kentucky to expand Medicaid in 2014 and made Lockaby – along with 440,000 other low-income state residents – newly eligible for free health care under the state-federal insurance program. Enrollment gave Lockaby her first insurance in 11 years.

"It's been a godsend to me," said the former Ohio school custodian who moved to Kentucky a decade ago.

...But Lockaby is worried her good fortune could soon end. Her future access to health care now hinges on a controversial proposal to revamp the program that her state's Republican governor has submitted to the Obama administration.

Every month I post an entry about the official CMS Medicaid enrollment report, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees.

As of August 2016, total Medicaid enrollment continued to quietly increase for a total of 73.1 million people, with 15.7 million of that being mainly due to the ACA (~11 million via official expansion, ~1 million early additions/transfers and ~4 million "woodworkers").

I know you're supposed to only use a brief paragraph or two, but this Sept. 19th AP/New Orleans Times-Picayune story only consists of five sentences anyway:

BATON ROUGE — The number of people who have signed up for Louisiana's Medicaid expansion program continues to grow, surpassing 300,000.

The Louisiana Department of Health released the latest figures Monday, saying more than 304,000 people are enrolled for the coverage that began July 1.

The department says nearly 12,000 Medicaid expansion enrollees have received preventive services through the government-finance insurance program so far, like cancer screenings, colonoscopies, and mammograms.

 The maximum number of Louisianans eligible for Medicaid expansion in the state is supposedly around 375,000. Enrollment began in June (though the program didn't actually go into effect until July), so that's 81% of the total enrolled within just 3 1/2 months.

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