More About Jesse Cross-Call

Jesse Cross-Call

Jesse Cross-Call is a Policy Analyst in the Health Policy division of the Center on Budget and Policy Priorities. In this role he examines issues related to the implementation of health reform and provides information and technical assistance to state and local officials, providers, and nonprofit organizations who are working on issues related to expanding coverage to the uninsured through Medicaid and the new health reform marketplaces.

Full bio and recent public appearances | Research archive at CBPP.org


Wisconsin’s Growing Cost of Not Adopting Medicaid Expansion

February 20, 2015 at 1:05 pm

Governor Scott Walker’s decision not to adopt health reform’s Medicaid expansion will cost the state $345 million in forgone budget savings over the next two fiscal years, the nonpartisan Legislative Fiscal Bureau estimates.  That’s $30 million more than the bureau estimated in August.  (The August report also estimated that adopting the expansion would have saved the state $206 million in the past two years.)

Under health reform, the federal government picks up 100 percent of the cost of expanding Medicaid through 2016 and at least 90 percent thereafter.  To receive this special matching rate, though, states have to expand Medicaid eligibility for adults up to 138 percent of the poverty line.

Governor Walker chose instead to extend Medicaid to adults only up to the poverty line through a separate waiver, so Wisconsin receives its regular matching rate, under which the federal government pays 58 percent of the cost of covering this population.  The $345 million in projected savings reflects the higher matching rate Wisconsin would receive by adopting the full expansion.

Other states also face forgone savings if they don’t adopt the Medicaid expansion this legislative session.  In Idaho, a workgroup put together by Governor Butch Otter estimates the expansion would save the state $173 million over the next ten years.  And in Alaska, Governor Bill Walker’s administration estimates the expansion would save the state $6 million next year.

Medicaid Eligibility for Low-Income Adults Lags Badly in Non-Expansion States

January 22, 2015 at 12:51 pm

The 23 states that haven’t expanded Medicaid as part of health reform have very limited Medicaid eligibility for non-elderly low-income adults, the latest annual survey of state health program officials from Georgetown University’s Center for Children and Families and the Kaiser Family Foundation finds.  That’s a key reason why 4 million uninsured adults remain in a “coverage gap” in non-expansion states, with incomes too high for Medicaid but loo low for subsidies to buy coverage through health reform’s marketplace.

By and large, non-expansion states have kept Medicaid eligibility for low-income adults at the very low income levels in place before health reform took effect.  In the typical non-expansion state, parents only qualify for Medicaid if they have incomes less than 45 percent of the poverty line, or less than $9,000 a year for a family of three, according to the report.  And in nearly every non-expansion state, non-disabled non-elderly adults without children don’t qualify for Medicaid no matter how low their income is.  (See chart.)

By comparison, in the 27 states and the District of Columbia that have expanded Medicaid, non-elderly adults with incomes below 138 percent of the poverty line ($27,000 for a family of three) are eligible for Medicaid.

Most of the 4 million adults in the coverage gap either work or are in a family with a worker, the Kaiser Family Foundation previously reported.  Research shows that for most low-wage workers, their employer either doesn’t offer coverage or doesn’t offer coverage that they can afford.

States that have expanded Medicaid have enjoyed especially large gains in insurance coverage since health reform’s major coverage expansions took effect in January 2014.  For states like Idaho, Utah, and Montana, which are seriously considering expanding Medicaid this year and have very limited Medicaid eligibility, the Medicaid expansion offers a surefire way to achieve similar progress.

Tennessee Proposal Shows Growing Momentum for Medicaid Expansion

December 16, 2014 at 12:44 pm

Contrary to some predictions, November’s election results haven’t stalled momentum among states to adopt health reform’s Medicaid expansion.  Tennessee Governor Bill Haslam yesterday became the sixth governor — and third Republican — in the past two months to announce an expansion plan.  Twenty-seven states and Washington, D.C. have already expanded (see map).

If the federal government and Tennessee’s legislature approve it, Governor Haslam’s “Insure Tennessee” plan would extend coverage to more than 200,000 uninsured Tennesseans through a demonstration project, or “waiver.”  The federal government has approved four states’ expansion waiver proposals, which give them added flexibility over their Medicaid programs.

Insure Tennessee contains elements that the federal government has approved for other state waivers.  As in Michigan, for example, newly eligible Tennesseans with incomes above the poverty line would make monthly contributions to individual accounts to cover their premiums and cost-sharing charges.  As in New Hampshire, newly eligible Tennesseans who had an offer of coverage from their employer but couldn’t afford the premiums would get help buying it.

To date, only three southern states have expanded Medicaid, which means most of the region isn’t experiencing the positive impacts from expansion.  The Kaiser Family Foundation reported that 86 percent of Americans in the “coverage gap” — with incomes too high for Medicaid but too low for federal subsidies to buy coverage through the marketplace — live in the South.

Among the three southern states that have expanded Medicaid, Arkansas and Kentucky report the nation’s largest drops in their uninsured rates this year (10.1 and 8.5 percentage points, respectively), and West Virginia’s uninsured rate has dropped 5.7 points.

Elsewhere in the South, Virginia Governor Terry McAuliffe will include a Medicaid expansion in his forthcoming budget, North Carolina Governor Pat McCrory has softened his opposition to expansion, and a group of Florida business leaders have unveiled their own expansion proposal.  These states, along with Tennessee, could take a big step toward closing the nation’s coverage gap.

Medicaid Expansion Isn’t Hurting State Budgets

December 9, 2014 at 10:59 am

State Medicaid spending rose just 2.7 percent in state fiscal year 2014, when health reform’s Medicaid expansion took effect in more than half of the states, a new report from the National Association of State Budget Officers (NASBO) estimates.  Along with Kaiser Family Foundation projections that state Medicaid spending in fiscal year 2015 (which began July 1 in most states) will grow more slowly in states that have expanded Medicaid than in the others, the NASBO report provides evidence that the Medicaid expansion isn’t hurting state budgets.

Both reports note a significant rise in total Medicaid spending — federal plus state — in fiscal year 2014 as 27 states plus Washington, D.C. extended eligibility to most people with incomes up to 138 percent of the poverty line.  Kaiser projects a 14 percent increase in total Medicaid spending in fiscal year 2015.

But since the federal government covers the entire cost through 2016 of covering people newly eligible for Medicaid due to the expansion (and no less than 90 percent after that), the story on state Medicaid spending is different.  Kaiser projects a 4.4 percent increase this fiscal year for Medicaid expansion states and a 6.8 percent increase for non-expansion states.

The NASBO and Kaiser reports focus on state Medicaid budgets, but Kaiser notes that expansion states will likely realize savings outside Medicaid, including in mental health, corrections, and state-funded programs for the uninsured.

As state legislative sessions approach, policymakers in a number of the 22 states that have yet to expand Medicaid are taking a fresh look.  Governors in Wyoming and Utah last week released details of their expansion plans.  These and other states considering the Medicaid expansion should note the mounting evidence that it’s no budget buster.

You can follow me on Twitter at @jcrosscall.

Renew CHIP — And Sustain Children’s Health Coverage Gains

November 14, 2014 at 3:11 pm

The share of children without health insurance remained at a historic low of 7.1 percent in 2013, Georgetown University Center for Children and Families’ annual report on children’s health coverage finds (see graph).   That’s down considerably from the 9.3-percent rate for 2008, the earliest year for which we have comparable data.  (The small change from 2012’s 7.2-percent rate wasn’t statistically significant.)

Along with Medicaid, the Children’s Health Insurance Program (CHIP) has been a major factor in reducing the ranks of uninsured children since its enactment in 1997.  However, states will get no new federal CHIP funding after September 2015 unless Congress acts.

And without new CHIP funding, as many as 2 million children could lose health coverage and become uninsured, the Government Accountability Office (GAO) estimates.

Congress should act as soon as possible to extend federal CHIP funding.  Otherwise, it risks derailing these substantial gains in children’s health coverage.