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PRESSURE THE STATES THAT ARE HOLD-OUTS TO
EXPAND MEDICAID. GIVE THEM THE SAME FEDERAL
FUNDING AS THOSE THAT PREVIOUSLY EXPANDED
We must pressure the states that have not expanded Medicaid to do so at once. This irresponsible decision leaves millions of vulnerable Americans without affordable health insurance options. These states are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.
The Affordable Care Act (ACA) extended Medicaid eligibility to almost all people with incomes at or below 138% of the poverty line as the mechanism to cover low-income individuals. Unfortunately, in 2012 the Supreme Court ruled that states could individually decide whether or not they wanted to take advantage of this provision.
The Supreme Court decision created a huge coverage gap because Medicaid expansion is the only financial assistance that the ACA provided for this group of people. This is a major problem because, without the expansion, the median income limit is just 43 percent of the poverty line.
Many people are critical of Medicaid outcomes, and certainly there is room for improvement (read more here). But many of the studies released do not take into account the fact that Medicaid recipients are unfortunately poorer and, therefore, often much less healthy than others. Here are just some of the reasons that Medicaid is important:
Evidence:
"Status of State Action on the Medicaid Expansion Decision." Henry J. Kaiser Family Foundation. 30 Aug 2020
Rachel Garfield, Kendal Orgera and Anthony Damico. "The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid." Henry J. Kaiser
Family Foundation. 21 Mar 2019
Jesse Cross-Call. "Medicaid Expansion Producing State Savings and Connecting Vulnerable Groups to Care." Center on Budget and Policy Priorities. 15
June 2016
Luojia Hu, Robert Kaestner, Bhashkar Mazumder, Sarah Miller, and Ashley Wong. "The Effect of the Patient Protection and Affordable Care Act Medicaid
Expansions on Financial Wellbeing." National Bureau of Economic Research. February 2018
Sarah Miller and Laura Wherry. "The Long-Term Health Effects of Early Life Medicaid Coverage." Robert Wood Johnson Foundation’s Health Policy Scholars
and Health & Society Scholars Programs at the University of Michigan, Ann Arbor. 15 July 2014
Laura R. Wherry, Sarah Miller, Robert Kaestner, and Bruce D. Meyer. "Childhood Medicaid Coverage and Later Life Health Care Utilization." National Bureau
of Economic Research. February 2015
Bruce D. Meyer and Laura R. Wherry. "Saving Teens: Using a Policy Discontinuity to Estimate the Effects of Medicaid Eligibility." National Bureau
of Economic Research. August 2012
David W. Brown, Amanda E. Kowalski, and Ithai Z. Lurie. "Medicaid as an Investment in Children: What Is the Long-Term Impact on Tax Receipts?" National
Bureau of Economic Research. January 2015
In a study by the Robert Wood Johnson Foundation’s Health Policy Scholars and Health & Society Scholars Programs at the University of Michigan, Ann Arbor, researchers "evaluated how a rapid expansion of prenatal and child health insurance coverage through the Medicaid program affected the adult health and health care utilization of individuals born between 1979 and 1993 who gained coverage in utero and as children."
"They found that those whose mothers gained eligibility for prenatal coverage under Medicaid have lower rates of obesity and lower body mass indices as adults. Using administrative data on hospital discharges, they found that cohorts who gained in utero Medicaid eligibility have fewer preventable hospitalizations and fewer hospitalizations related to endocrine, nutritional and metabolic diseases, and immunity disorders as adults. They found effects of public eligibility in other periods of childhood on hospitalizations later in life, but these effects are small. The results indicate that expanding Medicaid prenatal coverage had long-term benefits for the health of the next generation." Read the entire report here.
Another study from the National Bureau of Economic Research found "that having more years of Medicaid eligibility in childhood is associated with fewer hospitalizations and emergency department visits in adulthood for Blacks. The effects are particularly pronounced for hospitalizations and emergency department visits related to chronic illnesses and those of patients living in low-income neighborhoods."
"Furthermore, they found evidence suggesting that these effects are larger in states where the difference in the number of Medicaid-eligible years across the cutoff birthdate is greater. Calculations suggest that lower rates of hospitalizations and emergency department visits during one year in adulthood offset between 3 and 5 percent of the initial costs of expanding Medicaid." Read the entire report here.
Yet another study from the National Bureau of Economic Research showed "that Black children were more likely to be affected by the Medicaid expansions and gained twice the amount of eligibility as White children. They found a substantial effect of public eligibility during childhood on the later life mortality of Black children at ages 15-18. The estimates indicate a 13-20 percent decrease in the internal mortality rate of Black teens born after September 30, 1983." Read the entire report here.
A study from the National Bureau of Economic Research found "that the Medicaid expansions significantly reduced the number of unpaid bills and the amount of debt sent to third-party collection agencies among those residing in zip codes with the highest share of low-income, uninsured individuals. The estimates imply a reduction in collection balances of approximately $1,140 among those who gain Medicaid coverage due to the ACA. The findings suggest that the ACA Medicaid expansions had important financial impacts beyond health care use." Read the entire report here.
The National Bureau of Economic Research again: "We examine the long-term impact of expansions to Medicaid and the State Children's Health Insurance Program that occurred in the 1980's and 1990's."
"With administrative data from the IRS, we calculate longitudinal health insurance eligibility from birth to age 18 for children in cohorts affected by these expansions, and we observe their longitudinal outcomes as adults. Using a simulated instrument that relies on variation in eligibility by cohort and state, we find that children whose eligibility increased paid more in cumulative taxes by age 28. These children collected less in EITC payments, and the women had higher cumulative wages by age 28."
"Incorporating additional data from the Medicaid Statistical Information System (MSIS), we find that the government spent $872 in 2011 dollars for each additional year of Medicaid eligibility induced by the expansions. Putting this together with the estimated increase in tax payments discounted at a 3% rate, assuming that tax impacts are persistent in percentage terms, the government will recoup 56 cents of each dollar spent on childhood Medicaid by the time these children reach age 60."
"This return on investment does not take into account other benefits that accrue directly to the children, including estimated decreases in mortality and increases in college attendance. Moreover, using the MSIS data, we find that each additional year of Medicaid eligibility from birth to age 18 results in approximately 0.58 additional years of Medicaid receipt. Therefore, if we scale our results by the ratio of beneficiaries to eligibles, then all of our results are almost twice as large." Read the entire report here.
According to the Center on Budget and Policy Priorities, "Health reform’s Medicaid expansion has produced net budget savings for many states, new data show, and states such as Arkansas, Kentucky, Louisiana, and New Jersey expect continued net savings in coming years, even after they begin paying a modest part of the expansion’s cost. In part, this is because the expansion has lessened the burden on a patchwork of largely state-funded programs that connect people who are experiencing homelessness, have substance use disorders, or have other serious needs with critical health care services."
"Medicaid expansion is a good deal for states financially, as the federal government pays the entire cost of covering the new Medicaid enrollees through this year and no less than 90 percent of the cost thereafter. In expansion states there is now less demand for targeted Medicaid programs that serve low-income people with specific health conditions (such as certain women with breast and cervical cancers) but are funded at the state’s regular, lower matching rate, and for health programs that are entirely state-funded such as mental and behavioral health programs."
"Expansion states also are collecting more revenue from their existing taxes on health plans and providers, such as the managed care plans that serve Medicaid beneficiaries in many states, which have experienced a surge in enrollment due to expansion."
"The combination of these factors has produced savings for many state budgets. But Medicaid expansion is about more than the impact on state budgets. It also gives states an opportunity to provide needed care to uninsured people whose health conditions have been a barrier to employment. And for those leaving the criminal justice system, particularly those with mental illness or substance use disorders, access to care can reduce recidivism. Connecting these vulnerable populations with needed care can improve health, stabilize housing, and support employment." Read the entire report here.