An analysis by the nonprofit Kaiser Family Foundation estimates that the net benefit for these states would be $9.6 billion. 17. It reduces the number of uninsured by 3.2 million among people with incomes below 138 percent of FPL in nonexpansion states. Because she lives in Mississippi, "I wasn't going to be eligible for Medicaid because I don't have children [and] I'm not pregnant," she tells NPR. 1. What's next: Doggett introduced the bill earlier this month. A second has an enhanced premium subsidy schedule that also increases coverage among those with incomes above 138 percent of FPL. The biggest are Texas, Florida, and Georgia, but there are a few outside the South, including Wyoming and Kansas. States Who Still Have Not Expanded Medicaid According to a tracker provided by Kaiser Family Foundation, the 12 states that have not adopted Medicaid expansion are: 1. Expanding Health Coverage to the Poorest Residents of States That Have Advocates for expanding Medicaid in Kansas staged a protest outside the entrance to the statehouse parking garage in Topeka in May 2019. "Don't simply cave under the pressure of Democrats and their allies in the media who are pushing for the expansion of Obamacare, welfare and socialized medicine," Reeves said. When states don't expand Medicaid, women suffer - The 19th Privacy Policy, International Health Care System Profiles, Read the report to see how your state ranks, spur other nonexpansion states to reconsider, 2023 Scorecard on State Health System Performance, U.S. Supreme Court Preserves Medicaid Beneficiaries Rights, Medicaid Work Requirements Wouldnt Increase Employment and Could Imperil Future Labor Market Participation. This option results in the largest coverage gains, much of which is above 138 percent of FPL. A fourth idea, Rudowitz says, is to change the law to remove the minimum cutoff for the private health insurance exchanges, since "right now, individuals who are below poverty are not eligible for subsidies in the marketplace." Option 2 extends new nongroup or Medicaid coverage to 3.5 million people below 138 percent of FPL in nonexpansion states. Medicaid expansion increases Medicaid or nongroup coverage by 4.9 million below 138 percent of FPL. Filling the Gap in States That Have Not Expanded Medicaid In the middle of a pandemic, this has highlighted the precarious nature of not having coverage in a system thats so expensive, Blewett added. People who were under the poverty line were to be funneled to a newly-expanded version of Medicaid the public health insurance program that is jointly funded by states and the federal government. Parsons office in mid-August said the states social-services department would begin allowing individuals to apply for expanded Medicaid coverage, but that funding for the expansion remains an issue. The ARPA includes an additional temporary financial incentive for states to expand Medicaid. Ten states -- Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming -- have not accepted the Medicaid expansion. One study showed that every $100,000 of federal Medicaid spending translates to two additional workers in the economy.. Option 2 is like option 1 but with enhanced premium subsidies. I don't know what I'm going to do," she says. Costs are high because nonexpansion states tend to be low income, and several Florida, Georgia, North Carolina, and Texas have very large populations. If federal matching rates are increased in expansion states, federal spending increases by $12.1 billion, for a increase of $40 billion, or $480 billion over 10 years. First, the more generous subsidies apply also to people outside the gap (those with incomes above 100 percent of FPL), who are eligible for assistance with nongroup premiums. (In 2023, that's equal to $20,120 for an individual, or $41,400 for a family of four.). Indiana and a couple of other states have implemented disenrollment and lockouts for premium nonpayment using Medicaid Section 1115 waivers. To date, 10 states have resisted the coverage expansion offered by the Affordable Care Act. While states see $5.2 billion in new Medicaid spending because of required matching payments offset somewhat by lower spending on uncompensated care this does not take into account important savings to state governments. Subsidy estimates in this analysis are for nonexpansion states only, as they are necessary to make the coverage expansion work. Atlanta, GA 30318 Option 2 increases spending by the federal government in nonexpansion states by $22.5 billion in 2022 (the corresponding 10-year estimate is $270 billion). Improving Health Insurance Affordability Act of 2021, S. 499, 117th Cong. An analysis by the nonprofit Kaiser Family Foundation estimates that the net benefit for these states would be $9.6 billion. Five takeaways from Fox Newss prime-time shuffle, Supreme Court set to end limbo over Bidens student debt plan, Borrowers stare down student loan repayments after years of high inflation, Alabama governor calls special session to redraw congressional districts, How Wagners mutiny left Putin catastrophically weakened. Medicaid expansion thus does not cover as many people as Options 2 and 3 (enhanced subsidies), because there is no change in affordability above 138 percent of FPL. 14. If the South Dakota measure is approved, Florida and Wyoming will be the only remaining nonexpansion states with the option of expanding Medicaid by ballot initiative. "I'm stressed out about it. If the federal matching rate in expansion states were increased to 100 percent of FPL, federal spending would increase by another $12.1 billion; overall federal sending would increase by $27.2 billion, or $327 billion over 10 years. As a result, it costs the federal government more to cover low-income people than under the other two options, which have greater cost sharing and premiums. 5 (Oct. 2019): 53871. Exhibit 2 and Table 4 show the reduction in the uninsured (including the insured who leave noncompliant plans) by income level. South Carolina 8. Another complex issue in the debate over Medicaid expansion is the impact on state budgets after a state expands eligibility. Increased marketplace subsidies amount to $28.5 billion. Secure .gov websites use HTTPS 12. What's Next: When asked about progress on this front in an April press briefing, Biden's press secretary Jen Psaki said "the President is certainly supportive of and an advocate for states expanding Medicaid," but did not answer a follow up about whether the White House was directly reaching out to governors regarding this option. Feel free to republish and share widely. 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. But, so far publicly, at least no states have indicated they intend to take the federal government up on its offer. Prepandemic forecasts are from the Congressional Budget Office, The Budget and Economic Outlook: 2020 to 2030 (CBO, Jan. 2020). 15. To date, 31 states have expanded Medicaid, including Louisiana, where expansion is expected to take effect this year. Jake Johnson is a staff writer for Common Dreams. If the federal matching rate in expansion states were increased to 100 percent of FPL, federal spending would increase by $12.1 billion. 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. What is Medicaid expansion? | healthinsurance.org More than 110,000 thousand Arkansans have lost Medicaid since April, the third-largest disenrollment total in the country behind Florida and Arizona, according to data compiled by KFF. When she had her income checked for Healthcare.gov, it was just shy of the federal poverty line the minimum to qualify for subsidies. The COVID relief package's added funding for newly expanding states will save Missourians an . [3] This option not only extends assistance paying for coverage to those below 100 percent of FPL but also improves affordability for those throughout the income distribution. Nvidia, AMD stocks fall on report of new U.S. ban on AI chip exports to China, USPS issues warning over check fraud: Go directly to the post office to mail a check, Costco to clamp down on sharing of membership cards, She makes more than $10,000 a month through real estate, After Lordstown bankruptcy, shakeout expected in the EV market. Read on: Trying to strangle local governments: What happens when states and their cities become adversaries? Estimates for 2022, Access to Care Among Individuals Who Experienced Medicaid Lockouts After Premium Nonpayment, Key State Policy Choices About Medical Frailty Determinations for Medicaid Expansion Adults, Changing the Family Glitch Would Make Health Coverage More Affordable for Many Families, Health Insurance and Mortality: Experimental Evidence from Taxpayer Outreach, The Affordable Care Act Medicaid Expansions and Personal Finance, How Has the ACA Changed Finances for Different Types of Hospitals? https://doi.org/10.26099/21a4-hm38, Medicaid Expansion, State Health Policy and Medicaid, Health Insurance Marketplace, Health Insurance Premiums, Uninsured, 2023 The Commonwealth Fund. For example, Texas covers parents below 17 percent of FPL and Alabama 21 percent; childless adults are generally not covered in nonexpansion states. "@RichMuny @fvckinashman @RealSasquatch3 @Inkling61 @SenTuberville Red states have NO problem rejecting federal funds to expand Medicaid so that premiums go down Obamacare recipients." "Politics is a long game.". A lock ( Feehery: Is Democrats Mr. Louisiana, for example, expanded in 2016, projecting it would save $677 million over the following five years. Today, there are 12 holdout states that have not expanded Medicaid, and Mississippi is one of them. Households spend $6.0 billion less as more people buy health insurance. This is a dangerous place to be.. Florida is one of eleven states that hasn't expanded Medicaid because that's be communist slow creep. We cannot afford to come up short. Today, twelve states have still not expanded Medicaid. States that Do Not Expand Medicaid Rachel Garfield, Kendal Orgera, and Anthony Damico While millions of people have gained coverage through the expansion of Medicaid under the Affordable Care Act (ACA), state decisions not to implement the expansion leave many without an affordable It can be rapidly adapted to analyze various new scenarios from novel health insurance offerings and strategies for increasing affordability to state-specific proposals and can describe the effects of a policy option over several years. Bernard J. Wolfson, Covered California Announces Record-Low Rate Hike for 2021, California Healthline, Aug. 4, 2020; and New York State Department of Financial Services, DFS Announces 2021 Health Insurance Premium Rates, Protecting Consumers During COVID-19 Pandemic, press release; Aug. 13, 2020. ", "We urge you to move swiftly to use these tools to prevent more coverage losses among eligible children and adults in Florida, Arkansas, and other states," the lawmakers wrote, citing a " Exhibit 4 shows changes in spending for each option over 10 years (20222031). It also might amplify geographic equity concerns, she says. "Anything that expanded the footprint of the federal government and its role in subsidizing health care would be especially challenging," she says. Norris W. Cochran IV, Acting Secretary, U.S. Department of Health and Human Services, Letter to Governors Regarding the Public Health Emergency, HHS, Jan. 22, 2021. The Health 202: Democrats devise a way to finally expand Medicaid in Dan is a writer on CNET's How-To team. There are small reductions in the uninsured above 138 percent of FPL because of reductions in premiums as the risk pool improves. Fox News host suggests Trump may have leaked audio in classified documents Student loan debt: Borrowers brace for Supreme Court decision. 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. Studies have shown that Medicaid expansion saves lives,14 increases the financial security of the uninsured,15 and improves hospital finances.16 Marketplace coverage with fully subsidized premiums likely improves these three outcomes, though the magnitudes of the effects may differ from Medicaid expansion. 10. Millions of. "Even in policy areas where you don't have any kind of guaranteed victory, it is often worth fighting the fight," she says. The model is designed to incorporate timely, real-world data to the extent they are available. August 5, 2022 Jade Little, CCFadmin There are plenty of reasons for states to expand Medicaid. It also might amplify geographic equity concerns, she says. Overview of the ACA Medicaid Expansion - CRS Reports Option 3 extends eligibility to people with incomes below 100 percent of FPL but increases both premium and cost-sharing subsidies. Sarah Huckabee Sanders waits to deliver the Republican response to the State of the Union address by President Joe Biden on February 7, 2023 in Little Rock, Arkansas. This offers a broad benefit package and has no or nominal cost sharing. In this brief, we examine the coverage and cost impacts of three alternative approaches to filling the gap: Table 1 shows premium and cost-sharing subsidies under each of the three options. This option increases coverage the most for low-income adults. A .gov website belongs to an official government organization in the United States. Where States Stand on Extended Postpartum Medicaid Coverage Updated Insights from 2015 Cost Report Data (Urban Institute, Apr. This idea was included in Biden's 2022 budget, which says, in part: "In States that have not expanded Medicaid, the President has proposed extending coverage to millions of people by providing premium-free, Medicaid-like coverage through a Federal public option, paired with financial incentives to ensure States maintain their existing expansions.". People who were under the poverty line were to be funneled to a newly-expanded version of Medicaid the public health insurance program that is jointly funded by states and the federal government. More than 1 million people are dropped from Medicaid as states start a Across the six states that have expanded Medicaid through a ballot measure Idaho, Maine, Missouri, Nebraska, Oklahoma, and Utah an estimated 811,000 people have either enrolled or become . John Hanna/AP Some states are even working to make changes to the Medicaid program, including buy-in programs and putting lifetime caps in place. Medicaid coverage increases by a small amount. 16. Option 3 extends new nongroup or Medicaid coverage to 3.5 million people below 138 percent of FPL in nonexpansion states. Oklahoma and Missouri are the most recent states to have expanded Medicaid, both doing so in 2021. Eliminating the ACA: What Could It Mean for Medicaid Expansion? Most . Total health spending in nonexpansion states increases by $12.2 billion. 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.". Then the program becomes very popular., We know Medicaid is a good investment, so why is it being blocked? Oklahoma implemented Medicaid expansion on July 1, 2021. 3.7 Million People Would Gain Health Coverage in 2023 If the Remaining However, cost sharing is much lower in many states. 21. Since then, the following 12 states have implemented the expansion: Michigan (April 1, 2014), New Hampshire (July 1, 2014), Pennsylvania (January 1, 2015), Indiana (February 1, 2015), Alaska (September 1, 2015), Montana (January 1, 2016), Louisiana (July 1, 2016), Virginia (January 1, 2019), Maine (January 10, 2019), Idaho (January 1, 2020), Ut. All rights reserved. Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State, The Uninsured and the ACA: A Primer Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act, An Overview of State Approaches to Adopting the Medicaid Expansion. Option 1 extends coverage to 3.0 million people on net. We then inflated incomes and health costs to 2022. Methodology Endnotes As of February 2021, 12 states have not adopted the Affordable Care Act (ACA) provision to expand Medicaid to adults with incomes through 138% of poverty. United States, Copyright 2023, Georgia Public Broadcasting. "Anything that expanded the footprint of the federal government and its role in subsidizing health care would be especially challenging," she says. By signing up, you will receive newsletters and promotional content and agree to our. However, states also could see substantial savings and new revenue if they were to expand eligibility. Note that, unlike Medicaid, there are premiums of just over 2 percent of income, with disenrollment for nonpayment.8 Also, coverage is at 94 percent of actuarial value that is, plans cover 94 percent, on average, of the costs of covered health benefits while Medicaid coverage generally has zero or nominal cost sharing.9. Exhibit 3 and Table 5 show changes in spending for each option for 2022. Overall, the number of uninsured falls by 4.6 million. In the meantime, 12 states continue to leave millions of their residents without affordable health care options. sent a letter to the governor of every U.S. state expressing concern over the "high number of people losing coverage due to administrative processes" and reminding officials that they "must comply with federal rules regarding how they conduct" Medicaid renewals, including affording due process to those kicked off the program. Texas is one of 12 states yet to expand Medicaid. Her gallbladder is causing her pain, but she can't afford the surgery without shuffling household bills, and risking leaving something else unpaid. A locked padlock Total health spending in these states increases by $11.1 billion. Learn smart gadget and internet tips and tricks with our entertaining and ingenious how-tos. More than anything you want the other side to lose and you will literally bite off your nose to spite your face. "We never got anything saying we were booted out of the system.". Its easier to politicize the issue before it happens, to say this is Obamacare. Its very different once you start providing your residents healthcare. In 2018 the uninsured rate among low-income, non-elderly adults in expansion states was 17 percent, compared to 32 percent in non-expansion . Jessica Banthin et al., What If the American Rescue Plans Enhanced Marketplace Subsidies Were Made Permanent? Biden administration implores states to slow Medicaid slashes - USA TODAY There is a slight reduction in the uninsured above 138 percent of FPL. 13. It also increased federal matching funds for states that expanded their coverage. Today, there are 12 holdout states that have not expanded Medicaid, and Mississippi is one of them. Wright's inability to get a subsidized policy on Healthcare.gov is related to how the Affordable Care Act was originally designed. Those subsidies are, however, generally much lower than the cost of offering those people full Medicaid coverage. 12 Holdout States Haven't Expanded Medicaid, Leaving 2 Million People The total of the three spending components is the same as reported earlier, but small amounts reported as cost-sharing reductions should have been attributed to premium tax credits. A fourth idea, Rudowitz says, is to change the law to remove the minimum cutoff for the private health insurance exchanges, since "right now, individuals who are below poverty are not eligible for subsidies in the marketplace." 6. Some have advocated for circumventing these holdout states and creating a new, standalone federal Medicaid program that people who fall into this coverage gap could join. The U.S. economy was supposed to be teetering on the verge of recession by now. 250,000 Floridians Get Kicked Off Medicaid as DeSantis Rakes in Big Donor Cash , 15 Million People Could Lose Coverage as Nightmarish Medicaid 'Purge' Begins , 'Enormous Policy Failure': States Throw Hundreds of ThousandsIncluding Many ChildrenOff Medicaid , Coalition Convenes in DC to Fight 'American Death Sentence' of Poverty , 'A True Scandal, and Should Be Covered as Such': Outrage Over Medicaid Purge Grows , Thousands lose Medicaid in Arkansas: Is this America's future , 'Trying to survive': Families suddenly dropped from Medicaid seek .