2020 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

KFF.org updates est. of total uninsured eligible for Medicaid (appx. 2M less than previously thought)

Last year, the Kaiser Family Foundation ran an in-depth report which broke out a rough estimate of how many people in each state fell into various ACA categories (Medicaid expansion, eligible for QHP tax credits, not eligible due to being an undocumented immigrant, "Medicaid Gap" and so on). Based on that report, it looked like the total number of currently (at that time) uninsured people eligible for Medicaid--whether via expansion or "woodworker" status--was around 14 million, plus another 4.8 million who fell into the Medicaid Gap for non-expansion states.

More recently, KFF re-ran their numbers with more accurate/up-to-date data and posted modified tables for both those eligible for QHP enrollment (whether with or without tax credits), those caught in the Medicaid Gap and, over the weekend, the uninsured eligible for Medicaid. The "Gap" number is about 1.9 million fewer than the 4.8M they had previously estimated, partly due to updated/more accurate estimates, partly due to the fact that a couple more states (Michigan, New Hampshire & Pennsylvania in particular) have gone ahead and implemented expansion programs since then.

Similarly, their updated "total uninsured eligible for Medicaid" estimates are also about 2 million fewer nationally than they had previously estimated: 11.95 million instead of 13.99 million. In this case, the only state which actually changed status was Pennsylvania, which jumped from 224K to 586K; I presume this is due to them implementing their own expansion program starting in January. Other states mostly had their numbers reduced here and there, although a few others increased a bit.

It's important to bear in mind that the change in "uninsured eligible for Medicaid" is an updated estimate of how many were eligible as of last winter, not an estimate of how many are still eligible today. In other words, the reduced numbers aren't a matter of subtracting those who have been enrolled so far this year; if that were the case, instead of dropping by 2 million, it would have dropped by closer to 10 million or so.

So, based on this, what's the potential ceiling/cap on how much more Medicaid/CHIP enrollment could potentially increase over the next year?

Well, the following assumes that:

  • No further states expand Medicaid (which a few, such as Utah, Tennessee, Wyoming & Alaska are actually likely to do)
  • Around 85% of the Medicaid additions were previously uninsured (the other 15% being previously insured but paying through the nose for it)
  • The total net increase in Medicaid/CHIP enrollment was around 11.3 million through the end of November

If so, then it should be something like:

  • Uninsured eligible for Medicaid/CHIP as of December 2013 (including both expansion & woodworkers): Appx. 12.0 Million
  • Uninsured enrolled in Medicaid/CHIP through November 2014: Appx. 9.5 Million (around 80% of the total eligible)
  • Previously insured enrolled through November 2014: Appx. 1.8 Million

That would leave roughly 2.5 million uninsured people "on the table" to still be potentially enrolled, including 586,000 in Pennsylvania alone.

In other words, barring any additional expansion states popping up (which hold up to 3.86 million more potential enrollees), about 80% of the potential expansion/woodworker pool has likely already been enrolled nationally. Again, assuming an 85% previously uninsured rate, that means the maximum net increase would be something like 14.2 million total.