Federal Action Needed To Cover Those Left Out
Millions of uninsured people with low incomes have experienced none of the gains of expansion simply due to where they live. The differences in health outcomes between expansion and non-expansion states are stark. While, as noted above, Medicaid expansion has saved the lives of at least 19,200 adults aged 55 to 64 from 2014 to 2017, non-expansion has cost the lives of another 15,600 such adults. The impact of expansion on racial disparities is particularly salient, because more than half of those who remain uninsured due to their states refusal to expand are people of color, most of whom live in the South.
About 2.2 million adults with incomes below the poverty line are uninsured in the 12 states that havent expanded Medicaid . They have no pathway to affordable coverage because their incomes are too low to qualify for subsidies in the marketplace and they dont qualify for their states underlying Medicaid programs, which generally provide coverage for adults without a disability only for parents with very low incomes. Those who lack coverage are mostly people of color 28 percent are Black and 28 percent are Hispanic .
Revenue Impacts From Increased Economic Activity
States that decide to expand Medicaid turn on a spigot of federal funds. States that do not expand Medicaid do not receive a special tax break or grant equal to the amount of federal Medicaid dollars they have forgone. Thus, at the margin, the decision to expand Medicaid is in part a decision to bring a substantial amount of money into the states economy.
When new money enters a states economy, it boosts employment and income. Several studies have calculated the impact of Medicaid expansion on states economies.20 Most employ a statistical model used to estimate the number of jobs and amount of income generated by an event like Medicaid expansion. Using this method, researchers have estimated the economic impacts of Medicaid expansion in Michigan, Montana, Louisiana, Colorado, Kentucky, New Mexico, and Arkansas.21 These studies consistently find that Medicaid expansion generates significant economic impacts.
One national study uses a difference-in-differences approach to estimate the effect of Medicaid expansion on total employment in states where expansion had a large effect on overall insurance coverage.22 This study finds similar results as do the economic impact analyses. Medicaid expansion leads to significant increases in the size of expansion states health care sector and total employment .
Apply For Medicaid Coverage Even If Your State Hasnt Expanded
Even if your state hasn’t expanded Medicaid and it looks like your income is below the level to qualify for financial help with a Marketplace plan, you should fill out a Marketplace application.
Each state has coverage options that could work for you particularly if you have children, are pregnant, or have a disability. And when you provide more detailed income information you may fall into the range to save.
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Taxes Or Fees Tied To Medicaid Expansion
Several states have explicitly raised taxes and fees to cover their share of Medicaid expansion. Other states already had provider taxes or fees that grew naturally with expansion. According to the most recent 50-state Medicaid Budget Survey, 11 states fund the state portion of expansion with new or expanded taxes or fees.16 However, nearly every state has at least one type of provider fee used to pay for Medicaid, and several have expanded or changed these taxes/fees since Medicaid expansion .17 These taxes or fees are often explicitly tied to Medicaid expansion. However, they are also used to fund traditional Medicaid, and state funding data often do not allocate funds between different parts of Medicaid. This makes it difficult to quantify the share of these taxes that directly fund expansion.
Exhibit 7 describes several taxes implemented by states to cover all or part of the state share of Medicaid expansion. The table is limited to taxes/fees where the amount of revenue allocated to expansion is clearly stated. Consistent with the 50-State Medicaid Budget Survey, several states impose taxes that raise sufficient revenue to pay the full sticker price of expansion.
How Has Medicaid Expansion Reduced Racial Disparities
Racism, economic and health system inequities, limits on immigrants eligibility for Medicaid and other public health coverage, and many other factors have driven longstanding, harmful racial disparities in coverage, access to care, and health outcomes. While still large, these disparities have narrowed since the ACAs major coverage provisions took effect in 2014.
The gap in uninsured rates between white and Black adults shrunk by 61 percent in expansion states , while the gap between white and Hispanic adults shrunk by 43 percent in expansion states . Medicaid expansion has also helped lower uninsured rates among American Indians and Alaska Natives, with their non-elderly adult uninsured rate falling from 31 percent in 2013 to 20 percent in 2017 in expansion states, while falling only slightly in non-expansion states. Of those who could gain coverage if the remaining states adopted the Medicaid expansion, 60 percent are people of color.
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Quantifying The Benefits Of Closing The Coverage Gap
Closing the coverage gap would have tangible, meaningful benefits for low-income populations in nonexpansion states well beyond that of affordable, comprehensive health insurance. Some recent data points from the literature on the effects of expanded Medicaid coverage can be used to illustrate the magnitude of the impact of closing the gap on mortality, medical debt, and housing evictions.**
Reduced mortality
The benefits of Medicaid expansion for health care access and outcomes are well documented. Coverage improves peoples access to care and care utilization. States that have expanded Medicaid have seen lower rates of hospitalizations related to opioid use disorder as well as earlier detection of cancer. Medicaid expansion can literally save lives: It is associated with reductions in cardiovascular mortality, maternal mortality, infant mortality, mortality of the near-elderly, and overall mortality. Medicaid expansion has also been shown to narrow racial disparities in health outcomes, with gains in birth weight for Black infants and reductions in maternal mortality for Black women.
In a 2017 study, health economist Benjamin Sommers found that state Medicaid expansion was associated with one life saved annually for every 239 to 316 adults gaining insurance. Using the more conservative end of Sommers range, the authors estimate that covering the 2.2 million adults in the gap would result in about 7,000 fewer deaths each year.
Table 1
Less medical debt
Fewer evictions
The Impact Of Medicaid Expansion On State Spending
States must finance a share of the cost of expansion. As such, expanding Medicaid will increase state spending. However, expanding Medicaid also allows states to reduce spending on traditional Medicaid. Thus, the net increase in total Medicaid spending is smaller than the cost of expansion. Expanding Medicaid also may allow states to cut spending outside Medicaid particularly on programs that provide health services to low-income people.
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Option : Get Around Stubborn States By Letting Cities Expand Medicaid
Instead of centralizing the approach, this next idea goes even more local. The COVER Now Act, introduced by Rep. Lloyd Doggett, D-Texas, would empower local jurisdictions to expand Medicaid. So, if you live in Austin, Texas, maybe you could get Medicaid, even if someone in Lubbock still couldn’t.
The political and logistical challenges would be tough, policy analysts say. Logistically, such a plan would require counties and cities to create new infrastructure to run a Medicaid program, Rudowitz notes, and the federal government would have to oversee how well these new local programs complied with all of Medicaid’s rules.
“It does not seem feasible politically,” Michener says. “The legislators who would have to vote to make this possible would be ceding quite a bit of power to localities.” It also might amplify geographic equity concerns, she says. People’s access to health insurance would not just “be arbitrarily based on what state you live in which is the current state of affairs It’s also going to be arbitrary based on what county you live in, based on what city you live in.”
What’s next: Doggett introduced the bill earlier this month. There’s no guarantee it would get a vote on the House floor and even if it did it wouldn’t survive a likely filibuster in the evenly divided Senate.
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Will Any Of These Ideas Come To Fruition
Even with a variety of ideas on the table, “there’s no slam dunk option, it’s a tough policy issue,” Rudowitz says. All of these would be complicated to pull off.
It’s possible Democrats will include one of these ideas in a reconciliation bill that could pass without the threat of a Republican filibuster. But that bill has yet to be written, and what will be included is anyone’s guess.
Even so, Michener says she’s glad the discussion of the Medicaid coverage gap is happening, because it’s sensitizing the public, as well as people in power, to the problem and potentially changing the political dynamic down the line. “Even in policy areas where you don’t have any kind of guaranteed victory, it is often worth fighting the fight,” she says. “Politics is a long game.”
Copyright 2021 NPR. To see more, visit .
Red States Have Refused Medicaid Expansion Biden’s Funding Offer May Turn The Tide
An uninsured patient visited Dr. Gregory McCues practice in Cody, Wyoming, this week and explained that she cant afford insulin to treat her diabetes. McCue fears that the next time she returns to Cody Regional Health, it could be costly and life-threatening.
That patient, McCue said, will end up in the hospital and it will cost us $5,000 for a two-day stay instead of $200 to $300 a month it would have cost for her insulin. And because you cant get blood out of a turnip, thats uncompensated care that gets passed onto the hospital and the state.
Thats a weekly occurrence for him in Wyoming, he said, because the state hasnt expanded Medicaid, an option that could provide health care to thousands of working people in the state.
That could soon change, however.
On Wednesday, Republicans who long opposed the measure and Democrats who long supported it in the Wyoming House joined together to pass Medicaid expansion, potentially signaling the beginning of a change nationwide that could bring health care to those within the coverage gap.
Expanding Medicaid is an option available to states since 2014 through the Affordable Care Act, commonly known as Obamacare, yet Wyoming and 11 other states have refused to take up the federal governments offer. About 2.2 million people, who earn too much for Medicaid and too little for Obamacare subsidies, fall in that coverage gap nationwide, according to the Kaiser Family Foundation.
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Apply For Medicaid In Florida
Online at ACCESS Florida, or submit a paper application by mail, fax or in person to a local service center. For help with the application process, call 866-762-2237.
Eligibility: Children up to 1 year old with family income up to 206% of FPL children 1-5 with family income up to 140% of FPL children 6-18 with family income up to 133% of FPL pregnant women with family income up to 191% of FPL young adults 19-20 with family income up to 30% of FPL adults with dependents with family income up to 30% of FPL.People who qualify for Supplemental Security Income automatically qualify for Medicaid. For information: SSI-Related Programs Financial Eligibility Standards
What Did Medicaid Expansion Do
Medicaid expansion drives gains in health coverage among people who were previously eligible for Medicaid, including children and parents. Most children in families with low incomes were eligible for Medicaid before the ACA, but Medicaid eligibility for parents was limited and varied considerably across states.
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Mississippi Appealing To Better Angels
While policymakers in Mississippi from the Governor to legislative leaders are still generally opposed to expanding Medicaid, Lieutenant Governor Delbert Hosemann has a different view. While avoiding talk of directly expanding Medicaid, Hosemann has been repeatedly bringing up the plight of the many working Mississippians who cant get affordable coverage:
What is expansion of Medicaid? That is a lazy question, Hosemann retorted.What you need to be thinking about is how are we going to cover people who are working in Mississippi who have catastrophic illnesses? That is the real question.Hosemann told media members they need to focus on real life consequences instead of some nomenclature that is three presidents ago.
Those working hard in the state on making sure people have access to quality, affordable coverage welcome this change in focus. And even the Mississippi non-partisan state economists office has released a study showing the huge boost to the states economy with Medicaid expansion, outpacing even very large proposed tax cuts.
How Do I Enroll In Medicaid In Florida
Review Floridas eligibility criteria, and if you believe you are eligible to enroll in Medicaid you have several options:
- Enroll at Healthcare.gov .
- Apply online at ACCESS Florida, or fill out a paper form. Use this application for low-income children, pregnant women, families, and aged or disabled individuals who are not currently receiving Supplemental Security Income .
- Use this application to apply for food or cash assistance in addition to Medicaid. You should also use this form if you currently receive SSI or if you are applying for home-based and community services, hospice care, or nursing home care.
- Submit a paper application submitted by mail, fax or in person to a local service center.
For help with the application process, call 1-866-762-2237.
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How Does Medicaid Expansion Affect Peoples Health And Financial Well
Medicaid expansion makes people healthier and more financially secure by improving access to preventive and primary care, providing care for serious diseases, preventing premature deaths, and reducing the cases of catastrophic out-of-pocket medical costs, a large body of research shows. The benefits, also shown in Figure 4, include the following:
- Improved access to care. Medicaid expansion increased access to primary and preventive care for low-income adults . Michigans Medicaid expansion enrollees reported less forgone care and better access to care and the share of enrollees relying on the emergency room as their regular source of care dropped from 16.2 percent to 1.7 percent after their Medicaid enrollment. Medicaid expansion is associated with a significant rise in patients taking their medications as directed and with a decrease in low-income adults skipping their medication due to cost. Figure 3
Missouri An Expansion State With Major Delays In Enrolling Residents
Missouri voters chose to expand Medicaid in their state and expansion has been in effect for almost six months. Unlike other states that quickly enrolled nearly half their residents eligible for the new affordable coverage in the first few months, Missouri has lagged far behind, enrolling only about 25% of those eligible so far and putting many applications into an extended months-long waiting period for consideration a delay that violates federal law. Meanwhile, an effort in the Missouri legislature is building to again put a measure concerning Medicaid expansion on the ballot. This measure, if passed, would effectively allow legislators to repeal voter-passed Medicaid expansion.
As these debates continue at the state and federal level, many residents of the twelve non-expansion states are still looking for affordable, quality health coverage.
To see where your state stands on Medicaid expansion and other health policy-related options, visit our State Data Hub.
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How Does Medicaid Expansion Affect Employment
More than 80 percent of the non-elderly, non-disabled adults enrolled in Medicaid work full or part time, act as caregivers for family members or loved ones, or are students. Yet most jobs that Medicaid beneficiaries have or will likely get dont pay enough for them to shift into subsidized individual market coverage or offer employer-based coverage.
While expansion critics often say that Medicaid is a disincentive to work, expansion has not reduced labor force participation among those who become eligible for Medicaid. Medicaid, in fact, is an important work support because health coverage makes it easier for enrollees to look for a job and to work. Enrollees also say that having Medicaid coverage makes them better at their jobs. Medicaid expansion is a work incentive for people with disabilities those in expansion states are likelier to be employed than those in non-expansion states.
