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Tallying the Successes of Medicaid Expansion

December 7, 2015 at 1:45 PM

With threats to health reform and its Medicaid expansion continuing to loom, it’s worth looking at some of the successes that such an effort would endanger.  Specifically, the 30 states and the District of Columbia that have expanded Medicaid under health reform have realized big drops in their uninsurance rates and substantial budget savings, as I describe in a new National Institute for Health Care Management brief.

On the falling uninsurance rates, I note:

The [Affordable Care Act] coverage provisions are reducing uninsurance rates nationwide, with the biggest gains occurring in states that have expanded Medicaid.  New data from the American Community Survey show that between 2013 and 2014 the overall uninsurance rate fell by 3.4 percentage points in expansion states vs. 2.3 percentage points in non-expansion states. . . . With non-expansion states, as a group, starting off with higher uninsurance rates and seeing less improvement, their coverage disparity relative to expansion states has worsened.

And expansion states are saving billions:

These fiscal impacts are substantial, with one study estimating savings and revenue of $1.8 billion by the end of 2015 across the eight expansion states it examined. Furthermore, in three states making such projections, these newfound gains are expected to more than offset new state expenditures associated with the expansion through at least 2021, after the federal match rate for the expansion population has declined to its long-term level of 90 percent.

Meanwhile, need among uninsured adults in non-expansion states persists:

[I]n the 20 non-expansion states, an estimated 3.1 million adults are too poor to qualify for subsidized private coverage on [health reform’s new exchanges] but not poor enough to qualify for their state’s existing Medicaid coverage. . . .  Uninsured, they will remain highly reliant on safety net providers, when they are able to access the health care system at all, leaving them at risk of poorer health outcomes due to postponed or intermittent care and resulting in higher spending on uncompensated care.

Click here to read the full piece.


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