Medicaid Expansion Short Cuts: MI Mystery, NH switches flavors & more...

I have a ton of ACA-related stories cluttering up my in-box again; here's some of the more interesting ones, all regarding ACA Medicaid Expansion:


For months now, I've been a bit obsessed with figuring out how my home state's Medicaid expansion enrollment has managed to reach as high as 21% more people than were supposedly even eligible for the program. Estimates last year ranged from 477,000 - 500,000, yet enrollment in Healthy Michigan (Gov. Snyder's name for Obamacare Medicaid Expansion) currently sits at a whopping 579K, less than 1 year into the program.

Was it sloppy estimates in the first place? Is there some sort of FOX/Breitbart-style "Medicaid Fraud!!" book cooking going on? Or has the eligible pool simply shot up dramatically since those estimates came out due to economic shifts at the state or local level? I didn't give this last item much consideration since MI's unemployment rate has been steadily declining like the rest of the country (if slower than most states).

However, one theory I've been sent suggests that at least some of the "extra" 80-100K people may be connected to how former Detroit "Emergency Manager" Kevin Orr restructured the citie's debt:

Hi Charles,

I've been following your blog for the past year and a half. It's been a great narration of this journey. The reason I'm writing you is to alert you to a possible "culprit" in the Michigan Medicaid oversubscription. I have not bothered to do any actual work to uncover whether or not it IS the culprit, but thought I'd pass it along to you anyways.

Kevin Orr, emergency manager of Detroit, recently spoke at our conference [ed: the Annual Economic Outlook Conference at U of M in November 2014] and put up a slide about how he restructured all the existing debt. He didn't spend more than a second on it, but one of the big ones was the pension overhang. In a pretty ingenious move, he moved all the retirees onto the federal ACA exchange and agreed to pay some portion (maybe all?) of the premiums. This is a money-saver in part because so many of the retirees qualify for subsidies.

In addition to being an interesting point about how federal money can help troubled cities, I think there might be an increase in people who qualify for Medicaid under this scenario. Previously, they had health insurance. Now, they have a mandate to buy health insurance and a promise of assistance (I'm not sure what form that promise takes, I assume it is capped somehow). It's not hard to imagine that some of these guys went on the exchange and found out that they qualify for Medicaid, and Kaiser might not have estimated with those particular workers in mind.

Anyway, food for thought. If you track it down, it might make for an interesting resolution to a "problem" near to both of us.

I know very little about the intricacies of the Emergency Financial Manager situation or how Detroit's bankruptcy was handled, but this certainly sounds like a plausible scenario. Just figured I'd throw it out there; others who know this stuff better than I can comment further on it.


I was a bit confused when I read this headline, since New Hampshire already had agreed to expand Medicaid under the Affordable Care Act last year (though their program didn't kick in until July 1st). In fact, I've posted several stories about expansion in NH, and at last count they were up to around 25K people in the program.

New Hampshire strikes deal for Medicaid expansion

New Hampshire on Friday became the sixth state to earn approval from the federal government to launch its own version of the ObamaCare Medicaid expansion.

The plan will help about 35,000 uninsured people to buy private insurance plans. The program was negotiated by both the state’s Democratic governor, Maggie Hassan, and its GOP-controlled legislature.

However, I've since heard the forehead-slapping reason for the discrepancy: Apparently "standard" Medicaid expansion was only approved for 1 year, and now NH is switching to an Arkansas-style "Private Option" version of the program:

Democratic Gov. Maggie Hassan last year signed into law a bill that expanded Medicaid and created a temporary bridge program that allowed beneficiaries to go into the state's managed Medicaid plans. 

Had the waiver not been approved, expansion would have been phased out. As of March 3, 36,404 state residents had enrolled in the bridge program and as many as 50,000 people were estimated to be eligible for expanded coverage.

...The Voluntary Bridge to Marketplace program will continue through the end of the year. The state will begin purchasing private insurance for individuals once the next open-enrollment period begins Nov. 15 with coverage kicking in Jan. 1, 2016.

(Sigh) I guess this is better than losing the program completely, anyway. Plus, there's an impressive update on the number of enrollees in the 2nd story (over 36.4K through 3/03/15).


The big Obamacare news last week wasn't at the Supreme Court. It was in Kansas.

The Supreme Court got most of the attention on Obamacare this week, as it heard oral arguments in King v. Burwell. While that's an important case, the actual arguments don't change much: court-watchers know it's impossible to ballpark a case off of the single hour of public questioning.

The really big developments on Obamacare — ones that could actually expand coverage — weren't happening at the court. They were happening across the country, in statehouses.  As legislative sessions come to a close, three states are starting to weigh the possibility of signing on to Obamacare's Medicaid expansion.

Kansas, Utah, and Montana all took steps towards the coverage expansion this week, a move that could expand health-care coverage to 297,000 of their low-income residents. They're among the 22 states that have not expanded their Medicaid programs after the Supreme Court made that part of the health law optional in 2012.

The short version for each state (thanks to Esther F. for the summary):

  • Kansas -- From a "Hell, no!" situation to open-minded musing, given the state's difficult budget situation
  • Montana -- Where they didn't expand last session because one person voted wrong (between yes and no on a motion)
  • Utah -- One house of the legislature has voted for Arkansas style Medicaid, the other for regular Medicaid expansion

UGH. OK, strike 2 out of 3, probably:


Florida Senate to consider Medicaid expansion proposal

A Senate committee will consider a controversial plan Tuesday that would extend federally subsidized health insurance to more than 800,000 poor Floridians — but require a waiver from the federal government to pay for it.

The proposal (SPB 7044) would establish a state-run private insurance exchange available to Florida residents who earn less than $16,000 in annual income, or $33,000 for a family of four.

Beneficiaries would be required to work or attend school, and pay monthly premiums.



Auditors found an increase in revenue to doctors, hospital, and health-related industries in Kentucky. Cover Mississippi says, the state could gain 4.8 million dollars in new revenue to rural hospitals and 20 million a year to community health centers, by doing the same thing. Kim Robinson with the Children's Defense Fund says, Mississippians are funding states with exchanges to the tune of 1.8 million dollars and losing billions more.

"There is about nine billion dollars that we're leaving on the table, that could come directly into Mississippi that would help us to expand healthcare infrastructure and that would help us to increase healthcare jobs and to have an overall healthy Mississippi." said Robinson.

Cover Mississippi plans to hold meetings in cities across the state in June, where hospitals are being impacted by the refusal to expand Medicaid.