I last checked in on the "Georgia Pathways" program (the Peach State's partial-Medicaid expansion program which offiically extends up to 100% of the Federal Poverty Level but which also includes a draconian work reporting requirement) back in January.
At the time, only around 2,500 Georgians had actually enrolled in Georgia Pathways, for a number of rather obvious reasons:
Back in May I noted that North Carolina's ACA Medicaid expansion initiative, which started in December 2023, had officially enrolled more than 450,000 of the estimated 600,000 NC residents eligible for the program.
North Carolina Celebrates More Than 500,000 Enrolled in Medicaid Expansion
PRESS RELEASE — More than half a million North Carolinians have now enrolled in Medicaid expansion since the program began seven months ago. Beneficiaries are now able get the quality health care they need at low cost. Governor Roy Cooper was joined by North Carolina Department of Health and Human Services Secretary Kody Kinsley, Dr. Karen L. Smith MD, FAAFP, a family physician in Raeford and Verlina Lomick,CHW-IV, Director of Community Outreach & Advocacy for Kintegra Health and health care advocates to celebrate reaching this major milestone, which had originally been projected to take as long as two years.
Just yesterday I noted that the Michigan state senate has passed a bill to establish a state-based ACA exchange, joining 21 other states (Georgia is scheduled to launch theirs this fall, and Illinois in time for the 2026 Open Enrollment Period). The bill now moves to the state House, where I'm expecting it to pass and be signed into law by Gov. Whitmer without too much controversy. If so, Michigan would also split off of the federal exchange in time for the 2026 OEP.
Well, it turns out that another state may end up beating Michigan to the punch, and it's probably the last state you'd expect it to happen in: Mississippi!
Cut to 2024: Michigan Democrats now hold control of the state Senate as well as (barely) the House...and Democratic Representative Kevin Hertel is now Senator Kevin Hertel, who also happens to be the Health Policy Committee Chair...and one of his priorities this session, according to his latest constituent newsletter, is indeed to move Michigan to a state-based ACA exchange:
Legislative Updates
Expanding Access to Health Care Through a State-Based Exchange
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Over at the Wiley Online Library, Aleka Gurel, Director of Government Affairs at HealthSherpa, has published an excellent, in-the-weeds analysis of the history & impact of private insurance brokers & agents on ACA marketplace (on exchange) enrollment.
Here's an excerpt (note that this website is actually among the data sources she cites):
Across these 19 states alone, ACA Medicaid expansion enrollment is up 788,245 people since last March, or 6.7% overall. If you remove Missouri and Oklahoma, it's still up 4.28% since then, and again, this is still as much as 8 months out of date depending on the state. Assuming Illinois is wrong, removing it as well puts expansion enrollment up 5.4% since last March.
Assuming these states are representative, it's safe to assume that Medicaid expansion is up at least 4.3% nationally since March 2022, or around an additional 960,000 people. If you go with the higher end estimate (+5.4%), it would be up over 1.2 million nationally.
That puts the grand total at somewhere between 39.9 - 40.1 million people with ACA-enabled healthcare covered nationally.
Every month for years now, the Centers for Medicare & Medicare Services (CMS) has published a monthly press release with a breakout of total Medicare, Medicaid & CHIP enrollment; the most recent one was posted in late February, and ran through November 2022.
In March 2024, 82,751,338 individuals were enrolled in Medicaid and CHIP, a decrease of 636,453 individuals (0.8%) from February 2024.
75,645,578 individuals were enrolled in Medicaid in March 2024, a decrease of 644,997 individuals (0.8%) from February 2024.
7,105,760 individuals were enrolled in CHIP in March 2024, an increase of 8,544 individuals (0.1%) from February 2024.
As of March 2024, enrollment in Medicaid and CHIP has decreased by 11,116,668 individuals (11.8%) since March 2023, the final month of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) and amended by the Consolidated Appropriations Act, 2023.
Medicaid enrollment has decreased by 11,084,981 individuals (12.8%).
CHIP enrollment has decreased by 31,687 individuals (0.4%).
Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 23,023,434 individuals (32.5%) to 93,868,006.
Medicaid enrollment increased by 22,681,263 individuals (35.4%).
CHIP enrollment increased by 342,171 individuals (5.0%).
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
