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.
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.
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.
Regular readers know that I used to regularly post an entry about the official CMS Medicaid enrollment reports every month, 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 November 2015, there had been a net increase of 14.1 million people added to the Medicaid rolls since October 2013 (the month when ACA expansion enrollment began), plus another 950,000 people who had already been quietly transferred over to Medicaid from existing, state-funded programs prior to 2013 via other ACA provisions. I sort of forgot to post about the reports for awhile, but checked back in again for the May report, released back in July.
That's a net increase of 12,277 people in just 9 days, or over 1,300 per day.
There are an estimated 375,000 Louisianans eligible for ACA Medicaid expansion. If they can enroll another 700/day, they'll have maxed out by New Year's Eve.
Patients burst into tears at this city’s glistening new charity hospital when they learned they could get Medicaid health insurance.
In Baton Rouge, state officials had to bring in extra workers to process the flood of applications for coverage.
And at the call center for one of Louisiana’s private Medicaid plans, operators recorded their busiest day on record.
The outpouring began in June, when Louisiana became the 31st state to offer expanded Medicaid coverage through the Affordable Care Act, effectively guaranteeing health insurance to its residents for the first time.
Now, as Republican presidential nominee Donald Trump promises to repeal the healthcare law, Louisiana is emerging as a powerful illustration of the huge pent-up demand for health insurance, particularly in red states where elected officials have fought the 2010 law.
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Almost exactly 1 year ago, both Andrew Sprung and I realized that due to an overlap in two provisions of the ACA, a significant chunk of exchange enrollees would actually be eligible for Medicaid instead of a private QHP...if the remaining Republican holdout states were to stop being jackasses and expand the program already.
Why? Because while ACA Medicaid expansion covers people up to 138% of the Federal Poverty Line, QHP financial assistance applies to those with incomes between 100-400% of the FPL. In other words, anyone enrolled in a private exchange policy between 100-138% FPL in a NON-expansion state would automatically become eligible for Medicaid instead the moment that state expanded their Medicaid program via the ACA.
Unfortunately, there was no way of knowing exactly how many people this applied to, because until now, the HHS Dept. only broke out exchange enrollee income brackets into 50% chunks (ie, they listed 100-150% FPL, but not 100-138%).
A few weeks ago I noted that thanks to the election of Democratic Governor John Bel Edwards (with an assist by David Vitter's diaper fetish), up to 375,000 lower-income Louisiana residents became eligible for the ACA's Medicaid expansion provision starting a month earlier than expected (June 1st instead of July 1st).
Enrollment officially started early this morning (not sure if it was right at midnight or if they had to wait until the state offices opened or whatever), and as of around 11:40am...
Gov. Edwards announces that there are already 175,000 Louisianans enrolled in the expanded Medicaid program. #lagov#lalege
— Gov John Bel Edwards (@LouisianaGov) June 1, 2016
28,524 additional people were enrolled in July 2015 as compared to June 2015 in the 51 states that reported comparable July and June 2015 data.
Yes, that's right: The net total number of Medicaid/CHIP enrollees went up fewer than 30,000 people in July.
It's worth noting that the improving economy may be a significant part of this. Remember that this is the net number of enrollees; for all I know, 300,000 new people joined the program but 270,000 who were already on it left. Baseline churn is tricky to keep track of.
However, the more likely cause is far simpler: ACA Medicaid expansion has simply finally maxed out in most of the states allowing it, and most of the "woodworker" crowd has presumably finally figured out that they're eligible as well.
