Medicaid Expansion

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The American Rescue Plan does plenty to make private ACA-compliant health insurance dramatically more affordable for everyone earning more than 100% of the Federal Poverty Level. For those below 100% FPL, however, it takes an indirect approach. As I wrote a few weeks ago:

One possible "solution" would have been to simply remove the lower-bound income cut-off point for ACA exchange subsidy eligibility (that is, to lower the threshold from 100% FPL to 0%)...However, this would create two new problems: First, Medicaid is far more comprehensive than nearly all ACA plans...Secondly, if the lower-end subsidy cut-off were removed, it's almost certain that quite a few states which have already expanded the program would reverse themselves and allow Medicaid expansion to expire, in order to save the 10% portion of the cost that they have to pay.

The Maryland Health Benefit Exchange has issued a new press release which on the surface doesn't seem terribly unusual--it touts an impressive number of Maryland residents having gained healthcare coverage since they first launched their COVID-19 Special Enrollment Period (SEP).

What's unusual about this PR is that it's listing the cumulative number of people who've gained coverage since they launched their first COVID SEP a year ago:

MORE THAN 140,000 COVERED SINCE MARYLAND HEALTH CONNECTION LAUNCHED COVID-19 SPECIAL ENROLLMENT ONE YEAR AGO

  • 236,000 WHO STILL LACK COVERAGE COULD GET IT FOR FREE OR WITH SIGNIFICANT FINANCIAL HELP

(MARCH 17, 2021) BALTIMORE — Yesterday marked one year since the Maryland Health Benefit Exchange launched a Coronavirus Emergency Special Enrollment Period in response to the public health emergency declared by Gov. Larry Hogan.

Bribe

I'm a couple of weeks behind on this (the full #AmRescuePlan, #HR1319, already passed the House late last Friday night), but Medicaid expansion is one of the core issues I cover here, so it didn't feel right not to give this a write-up.

Before the Affordable Care Act was passed, only certain populations were eligible for Medicaid. Low-income children, pregnant women, parents of minor children and those with certain disabilities and so forth were eligible up to a certain household income threshold ranging from as a ceiling of as little as 13% of the Federal Poverty Line (parents in Alabama) to as much as 375% FPL (pregnant women and newborn infants in, interestingly, Iowa).

 

Nearly six years ago:

In other words, only about 10% (at most) of those still in the Medicaid Gap could remotely match the GOP's cliche of a "lazy, good-for-nothing layabout" type who's able-bodied, has no serious extenuating circumstances and so forth. The "get off your ass and work!" requirements appear to be nearly as big a waste of time and resources as the infamous "drug testing for welfare recipients" bandwagon which a bunch of states jumped on board over the past few years.

Back in November I noted that enrollment in Medicaid via ACA expansion has increased dramatically here in Michigan since the COVID-19 pandemic struck, increasing by 23% from 673,000 in February 2020 to 829,000 in November.

Today the Michigan Dept. of Insurance & Financial Services just issued the following press release:

More than 1 Million Michiganders Obtained 2021 Health Coverage from the Health Insurance Marketplace and the Healthy Michigan Plan

(LANSING, MICH) After an extensive joint outreach campaign by the Michigan Department of Insurance and Financial Services (DIFS) and the Michigan Department of Health and Human Services (MDHHS), more than 1 million Michiganders obtained health coverage for 2021 during the Health Insurance Marketplace open enrollment period or through the state’s expanded Medicaid program. 

Back on December 19th, my colleagues Colin Baillio and Andrew Sprung picked up on something I had posted in response to the semi-final 2021 Open Enrollment snapshot report:

STATE LEVEL:
--25 out of 36 states outperformed last year
--Best % increase y/y: TEXAS (+14.9%)
--Worst $ decrease y/y: KENTUCKY (-6.7%)

I have no idea if there's anything special in either state which caused either to do as well/poorly as they did relative to last year.

Sprung decided to look into it further. He broke out the states between Medicaid expansion and non-expansion states, and voila:

From the state totals one obvious pattern leaps out: enrollment is up 9.7% in states that have not enacted the ACA Medicaid expansion -- and down 0.5% in states that have expanded the expansion (including Nebraska, which opened the Medicaid expansion doors in October of this year).

In my Twitter thread yesterday breaking out the semi-final HC.gov weekly snapshot enrollment report, I noted:

STATE LEVEL:
--25 out of 36 states outperformed last year
--Best % increase y/y: TEXAS (+14.9%)
--Worst $ decrease y/y: KENTUCKY (-6.7%)

I have no idea if there's anything special in either state which caused either to do as well/poorly as they did relative to last year.

My colleagues Colin Baillio and Andrew Sprung took note of this, and Sprung decided to look into it further. He broke out the states between Medicaid expansion and non-expansion states, and voila:

From the state totals one obvious pattern leaps out: enrollment is up 9.7% in states that have not enacted the ACA Medicaid expansion -- and down 0.5% in states that have expanded the expansion (including Nebraska, which opened the Medicaid expansion doors in October of this year).

I suppose this was inevitable, but it's grating nonetheless, and especially so given that we're in the middle of a pandemic which has caused tens of millions of Americans to lose their jobs:

The Supreme Court agreed Friday to consider a Trump administration plan to let states impose work requirements on some who receive health-care benefits under the Medicaid program for the poor.

Arkansas and New Hampshire want to continue programs halted by lower courts, and more than a dozen other states say they want to impose similar requirements.

But despite the Supreme Court’s willingness to take up the issue, the incoming Biden administration might have other ideas, and opponents called on it to reverse endorsement of the work requirements.

Over at Xpostfactoid, my colleague Andrew Sprung has been doing a great job of tracking ACA Medicaid expansion enrollment growth since the onset of the COVID-19 pandemic this past February/March at the macro (national) level, by looking at around a dozen states which have monthly reports available. He puts the overall enrollment growth rate at 23.6% from February thorugh October 2020.

I've decided to take a closer look at individual states. The graph below shows how many Coloradoans have been actively enrolled their Medicaid expansion program:

Over at Xpostfactoid, my colleague Andrew Sprung has been doing a great job of tracking ACA Medicaid expansion enrollment growth since the onset of the COVID-19 pandemic this past February/March at the macro (national) level, by looking at around a dozen states which have monthly reports available. He puts the overall enrollment growth rate at 23.6% from February thorugh October 2020.

I've decided to take a closer look at individual states. The graph below shows how many Arizonans have been actively enrolled their Medicaid expansion program (awkward named the Arizona Health Care Cost Containment System, or AHCCCS):

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