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

Two Takeaways From New Hampshire and Michigan’s Medicaid Expansions

March 31, 2014 at 11:40 am

New Hampshire’s legislature has passed and Governor Maggie Hassan has signed into law legislation that will expand Medicaid as part of health reform effective July 1.  This means that combined with Michigan, where expansion takes effect tomorrow, an additional 600,000 uninsured people will be newly eligible for Medicaid coverage.  It also means a majority of states have taken health reform’s Medicaid expansion, as our map shows.

For policymakers in Maine, Missouri, Utah, Virginia, and other states currently debating whether to expand, the news from New Hampshire and Michigan offers important lessons:

  • Federal officials are willing to work with states to craft reasonable expansion plans.  The legislation passed in New Hampshire directs state officials to pursue a demonstration project — often called a “waiver” — that would use Medicaid dollars to buy coverage for newly eligible beneficiaries through the marketplace.  If approved, this approach would be similar to those in place in Arkansas and Iowa.

    New Hampshire likely will gain federal approval for its demonstration project because it steered clear of onerous provisions being discussed in other states that would make it difficult, if not impossible, for people to gain and maintain coverage.  For example, policymakers in Pennsylvania and Missouri have discussed tying people’s Medicaid eligibility and premium obligations to whether they are working or actively looking for work.  Such provisions have no relation to the purpose of Medicaid, which is to provide health coverage to people with low incomes.

  • States can expand at any time, but the sooner, the better for states and the uninsured.  The Medicaid expansion is a great deal for states, but especially so from now through the end of 2016 while the federal government pays the entire cost of covering the newly eligible.  (The federal government will pay no less than 90 percent of the cost in the years thereafter.)  While New Hampshire’s proposed waiver will not take effect until January 1, 2016, newly eligible beneficiaries will be able to enroll in the state’s existing program on July 1 of this year.  This is a win for both the Granite State’s finances and for the uninsured.

Failing to Expand Medicaid Costs Individuals, Too

February 10, 2014 at 4:07 pm

We’ve written about the growing cost to states of not expanding Medicaid as part of health reform.  But let’s not forget that state policymakers’ decisions not to expand have a severe human cost, too, as an article in today’s Wall Street Journal makes clear.

The Journal details the plight of uninsured low-income workers in Alabama — one of the states that hasn’t expanded Medicaid — who are struggling to afford medications for chronic health conditions, or are forgoing needed care entirely because they lack health coverage.  These are some of the nearly 5 million individuals in 25 states caught in a “coverage gap” — with income too low to qualify for help buying private coverage through the new marketplaces and too high to qualify for Medicaid — that exists because their state has not expanded Medicaid (see chart).

While Alabama Governor Robert Bentley opposes the expansion, a growing number of policymakers in non-expansion states are realizing that it doesn’t have to be this way.  Utah Governor Gary Herbert has announced he will push to expand this year because “doing nothing is not an option.”  And lawmakers in Nebraska, New Hampshire, and a handful of other states are charting their own paths toward expansion.

The Medicaid expansion is a good financial deal for states, and they can expand with the knowledge that the federal financial commitment to the expansion is solid, as we’ve previously explained.  Today’s Journal makes it clear how much individuals stand to gain from expanding as well.

The Growing State Cost of Not Expanding Medicaid

January 16, 2014 at 10:37 am

Policymakers in some of the 25 states that haven’t expanded Medicaid as part of health reform (see map) are putting expansion at the top of this year’s legislative agenda.  The New Hampshire House passed an expansion bill on the first day of its session last week, for example, and Virginia Governor Terry McAuliffe advocated for expansion in his first address to lawmakers.  These policymakers are wise to prioritize the Medicaid expansion, as the costs of not expanding have begun to accrue:

  • States’ failure to expand has created a “coverage gap” containing nearly 5 million people.  People in this gap — which includes more than a quarter of the uninsured, non-elderly adults in these 25 states, according to a recent analysis by the Kaiser Commission on Medicaid and the Uninsured — are shut out of health reform’s coverage options.  Their income is too low to qualify for help buying private coverage through the new marketplaces and too high to qualify for Medicaid.
  • States that haven’t expanded are missing out on a very good financial deal.  The federal government will pick up 100 percent of the cost of covering newly eligible people through 2016 and no less than 90 percent of the cost after that.  So, the amount of federal money that states forgo by not expanding will continue to grow.
  • States that have expanded expect slower growth in state Medicaid costs than states that haven’t expanded.  This finding, from a recent Kaiser survey of states, reflects the fact that expansion states anticipate savings in state-funded services that they have provided to uninsured individuals who are now eligible for Medicaid.  Examples include mental health care, corrections-related health care, and uncompensated care.

Iowa’s Medicaid Expansion Has Lessons for Other States

December 16, 2013 at 2:15 pm

The Department of Health and Human Services (HHS) last week approved Iowa’s proposal to adopt health reform’s Medicaid expansion through a pair of demonstration projects, often called “waivers.”  As a result, more than 100,000 uninsured Iowans will be newly eligible for health coverage starting January 1.

That’s great news.  HHS’s decision is important for other states because it suggests that federal officials will work with states to craft a reasonable expansion plan but won’t approve proposals — like one from Pennsylvania Governor Tom Corbett, described below — that would make it hard or nearly impossible for eligible people to get needed coverage.

Under Iowa’s plan, the state will use Medicaid funds to buy private coverage in health reform’s new marketplace for people with incomes between 100 and 133 percent of the poverty line.  After the first year, people in this income range will pay roughly the same premiums as if they were receiving premium tax credits to buy coverage themselves through the marketplace.  But people who complete a wellness exam and an assessment of their health risks won’t have to pay premiums; nor will people who suffer financial hardship.

While approving those parts of Iowa’s plan, HHS denied Iowa’s request to charge premiums to beneficiaries with incomes below the poverty line and to cancel their coverage if they miss payments.  This maintains the important principle that poor people shouldn’t face premiums for health coverage.  Research shows that premiums reduce participation in Medicaid and make it harder for people to maintain coverage.

The limits that HHS imposed on Iowa’s plan are especially important given recent news out of Pennsylvania.  There, Governor Corbett has proposed expanding Medicaid but with requirements that would make it hard for many low-income people to qualify.

The governor’s plan would require people with incomes as low as 50 percent of the poverty line ($5,745 a year) to pay premiums.  It also includes stringent work requirements that would likely make it very difficult for many people to get or maintain health coverage.  It would, for example, force a single mother with two kids who is working fewer than 20 hours a week to jump through a series of administrative hoops in order to gain and maintain coverage.

These parts of Pennsylvania’s proposal go beyond the appropriate flexibility that HHS has given states.  Governor Corbett should abandon them, if he wants to take advantage of health reform’s opportunity to bring coverage to hundreds of thousands of Pennsylvanians.

States Can Reduce Kids’ Uninsured Rate Further by Expanding Medicaid

November 20, 2013 at 2:40 pm

The Georgetown University Center for Children and Families’ annual report on children’s health coverage, released today, brings welcome news:  the rate of children without health coverage fell for the fifth consecutive year, from 9.3 percent in 2008 to 7.2 percent in 2012 (see chart).

The report notes that state decisions whether to expand Medicaid under health reform, which would extend coverage to adults earning less than 133 percent of the federal poverty line ($25,975 for a family of three), will build on these gains in children’s coverage.  Here’s why:

Nearly 70 percent of the nation’s 5.3 million uninsured children are already eligible for Medicaid or the Children’s Health Insurance Program but are not enrolled, according to Georgetown’s researchers.  When states expand Medicaid for parents, the number of uninsured children falls, because parents are more likely to sign up their eligible children for coverage when the whole family can get coverage, research shows.  Research also finds that when parents have coverage, their children are less likely to experience breaks in coverage and are more likely to receive preventive care and other needed care.  As a result, making coverage available to more low-income parents through health reform’s Medicaid expansion should further reduce the ranks of uninsured children.

Twenty-five states and the District of Columbia already have decided to expand Medicaid next year.  As policymakers in Maine, New Hampshire, Pennsylvania, Tennessee, Virginia, and other states contemplate whether to expand their Medicaid programs, they should consider the positive impact that expansion will have on children’s health coverage and access to needed care.