More About Matt Broaddus

Matt Broaddus

Broaddus joined the Center in December 1999 and is a Research Analyst in the Health Division.

Full bio and recent public appearances | Research archive at

CHIP Success Is No Reason to Convert Much of Medicaid to Block Grants

March 19, 2015 at 2:48 pm

In proposing to convert much of Medicaid into two block grants, Senate Budget Committee Chairman Mike Enzi’s budget plan claims the Medicaid block grants would follow the successful Children’s Health Insurance Program (CHIP) model.  As we’ve explained, however, Medicaid under block grants would operate far differently than CHIP and would lead to damaging cuts to states, beneficiaries, and health care providers.

CHIP is funded through a block grant structure, yet it’s helped reduce the share of children without health coverage to a historic low.  That’s because Congress has taken extraordinary steps to ensure that states have had adequate federal funding to sustain (and expand) their CHIP programs, allowing them to overcome CHIP’s otherwise flawed capped funding structure.  In contrast, Medicaid block grants like those proposed by Chairman Enzi are explicitly designed to reduce federal funding well below current levels (and thus below states’ funding needs) in order to generate large savings.

Here are some of the key findings from our earlier analysis:

  • Over CHIP’s original ten-year authorization, overall federal funding for state CHIP programs was more than adequate to meet states’ funding needs. In contrast, Chairman Enzi’s plan would cut Medicaid spending by roughly $400 billion over ten years, on top of repealing health reform’s expansion of Medicaid coverage to low-income adults.
  • In CHIP, if a state doesn’t use its full amount of federal funding, the funds are redistributed to other states. Even if the Medicaid block grant envisioned under the Enzi plan allowed for redistribution of unspent funds — it doesn’t — there would be little or no unspent funds to redistribute because of the deep federal funding cuts relative to the funding states would receive under current law.
  • When redistributed CHIP funds fell short of closing states’ federal CHIP funding gaps, Congress stepped in between 2005-2009 to provide additional CHIP funding. As a result, states could operate their CHIP programs as though they had uncapped federal funding, as under Medicaid today.  The combination of states’ annual allotments, redistributed funds, and supplemental federal funding has given states all of the federal CHIP funding they’ve needed.
  • When President Obama and Congress extended CHIP funding for five years in 2009 (and further through 2015 as part of health reform), they set funding levels that both accommodated health care cost inflation and child population growth and allowed for further growth from enrolling a higher share of children eligible for the program. That’s why the Congressional Budget Office has estimated that no state would face shortfalls in federal CHIP funding.

CHIP has overcome the serious shortcomings of its financing structure because it differs substantially from typical block grants.  Under Chairman Enzi’s plan, the Medicaid block grants would not mirror CHIP’s success but instead likely result in states significantly cutting eligibility, benefits, and payments to health care providers.  Substantial numbers of low-income Medicaid beneficiaries would end up uninsured or underinsured.

Medicaid-Eligible Children Grow Up to Earn More and Pay More in Taxes

January 21, 2015 at 12:01 pm

People eligible for Medicaid in childhood earn more as adults, and thus contribute more in federal taxes, than other low-income people who weren’t eligible, a recent promising study published by the National Bureau of Economic Research (NBER) finds.  And those benefits, which help offset the cost of providing Medicaid coverage, grow with each year of eligibility.

These findings are the most recent evidence of Medicaid’s wide-ranging benefits to the nation as well as enrollees.  Nearly 30 million Medicaid enrollees — half of all people with Medicaid coverage — are age 18 or under.

Analysts from the Treasury Department and Yale University examined IRS data for people born just before Congress expanded Medicaid coverage for children in the mid- to late 1980s.  These people contributed $186 more in total taxes through age 28 for each additional year they were likely Medicaid-eligible as children.

Other findings from the study suggest potential explanations:  People with more years of likely Medicaid eligibility received less from the Earned Income Tax Credit, had lower mortality rates, were more likely to attend college, and (among women) had higher wages, for example.

Because of their increased tax contributions, “we conclude that the government recoups 14 cents for each dollar that it spent on Medicaid for children by the time they reach age 28,” the authors conclude.  By age 60, they add, the government recoups 56 cents on the dollar.

Although more research is needed to confirm these findings, the NBER-published study — the first to examine the long-term economic impacts of additional years of Medicaid eligibility — contributes to a larger body of research on Medicaid’s positive impacts both in and beyond health care.

Recent research in Oregon, for example, shows that enrolling in Medicaid improves access to health care and reduces medically related financial hardships.  Studies have also shown the long-term health benefits of expanding Medicaid, such as a national study finding that people more likely to be eligible for prenatal and infant care through Medicaid were healthier in young adulthood.

Adults’ Uninsured Rate Falls Further, Reflecting Big Gains Under Health Reform

January 8, 2015 at 4:26 pm

The share of adults without health insurance fell again to 12.9 percent in the fourth quarter of 2014, new survey results from Gallup and Healthways show.  This is down from 13.4 percent in the previous quarter and 17.1 percent in the fourth quarter of 2013, before health reform’s major coverage expansions — through Medicaid and subsidized marketplace coverage — took effect in January 2014.  (See chart.)  It’s also the lowest uninsured rate among adults since Gallup started collecting the survey data in 2008.

The uninsured rate fell sharply among all groups of adults in 2014, but some groups saw particularly large coverage gains.  For example, the share of African Americans without health insurance fell by a third, from 20.9 percent to 13.9 percent.  Likewise, young adults’ (ages 18 to 25) uninsured rate fell by nearly a third, from 23.5 percent to 17.4 percent.

Coverage gains among Hispanics were smaller, likely reflecting continuing outreach and enrollment challenges for that group.  Hispanics’ uninsured rate fell from 38.7 percent to 32.4 percent.

The new Gallup data are fully consistent with other independent surveys and federal government survey data showing significant coverage gains in 2014.

Further Health Coverage Gains, Especially in Medicaid Expansion States

December 17, 2014 at 2:08 pm

The number of uninsured Americans fell by 6.8 million over the first two quarters of 2014, preliminary data from the Centers for Disease Control and Prevention’s (CDC) National Health Interview Survey show.  These are the most up-to-date government survey data on the early impacts of health reform’s major coverage expansions, which took effect in January.  And they show a widening coverage gap between states that have adopted health reform’s Medicaid expansion and other states.

Superseding earlier CDC estimates, the new figures that the CDC released yesterday include the second quarter of 2014, when enrollment surged in state Medicaid programs and health reform marketplaces.  Together, the two reports show consistent progress across the year in reducing the ranks of the uninsured.

Some 12.2 percent of Americans were uninsured in the first six months of 2014, the CDC data show, a 2.2 percentage-point decline from 2013 and the lowest rate since the CDC first collected these data in 1997.  The uninsured rate has fallen by nearly a quarter since peaking at 16.0 percent in 2010.

Coverage gains were greatest among the population groups that have been least likely to have coverage.  The uninsured rate for people in families between 100 and 200 percent of the poverty line plummeted from 29.3 percent to 24.1 percent between 2013 and the first half of 2014.  Adults under age 26, Latinos, African Americans, and people with less than a high school education also experienced disproportionate gains.

Coverage gains among non-elderly adults were nearly twice as large in states that have expanded Medicaid as in non-expansion states, widening the gap between the uninsured rates in the two groups of states from 4.3 percentage points to 6.1 percentage points.  (See graph.)  Several more states are considering adopting the expansion, which would lead to further coverage gains.

The new CDC figures are consistent with four independent surveys showing significant coverage gains in 2014, particularly among Medicaid expansion states.

While the CDC data were collected in January through June, private survey data from the Urban Institute show further coverage gains in the third quarter of 2014, while survey data from Gallup show coverage rates holding steady over this period.

Low-Income Adults Favor Medicaid Expansion, New Survey Shows

November 13, 2014 at 4:06 pm

Four-fifths of low-income adults surveyed in three southern states favor health reform’s Medicaid expansion, a new Harvard School of Public Health study finds.  The first quantitative analysis of potential enrollees’ views on Medicaid, the survey included residents of Kentucky (which has adopted the expansion), Texas (which hasn’t), and Arkansas (which has expanded under a waiver that allows it to enroll the expansion population in private marketplace coverage).

The survey was conducted in December 2013, during health reform’s first open enrollment period (and before implementation of the Medicaid expansion), to maximize the likelihood that respondents were familiar with the concepts in the survey.

Large majorities of respondents also said they believe that Medicaid’s quality of care, access to physicians, and affordability rival or outperform private coverage.

Roughly two of every three uninsured low-income adults surveyed in each state planned to apply either for Medicaid or subsidized marketplace coverage, the survey also found.

State policymakers should take into account this strong support for Medicaid among low-income adults as they debate whether to take up the expansion.  Twenty-three states (including Texas) haven’t expanded Medicaid.  In addition, Arkansas’ private-option expansion may not get the funding needed to continue, despite covering some 200,000 low-income Arkansans.

While the Harvard survey found that low-income adults value Medicaid highly and would enroll if eligible, it also found that many residents didn’t know whether their state has adopted the expansion.  So, achieving the full benefits of the expansion will require not just convincing more states to adopt it but also making more low-income eligible adults aware of it so they enroll.