The Center's work on 'Insurance Coverage' Issues


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.

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.

Veterans and the Safety Net

November 11, 2014 at 1:01 pm

Veterans’ Day is an appropriate time to highlight some ways that the safety net helps many low-income veterans and active-duty members of the military make ends meet.  It’s important to note that policymakers’ actions in areas like health coverage and tax credits for working families have a big impact on veterans and their families.

SNAP (formerly food stamps):  Roughly 1.7 million veterans live in households that participate in SNAP at some point during the year, and roughly 980,000 live in households that participate in an average month.  SNAP provides an essential support for low-income veterans, who may be unemployed, working in low-wage jobs, or disabled.  Click here for more.

Housing assistance:  Roughly 343,000 veterans — most of them elderly or with disabilities — receive rental assistance to help them afford housing.  Rental assistance appears to have played a central role in the 33 percent decline in veterans’ homelessness since 2010 (see graph), and it allows veterans to devote more of their limited resources to other basic needs, like food or medicine.  Click here and here for more.

Health coverage:  Roughly 215,000 veterans in 23 states are uninsured and denied Medicaid because their state has refused to take up health reform’s Medicaid expansion.  Their income is too high for Medicaid under prior eligibility rules but too low to receive subsidies to buy private coverage through the new insurance marketplaces.  Click here for more.

Working-family tax credits:  Many families that include one or more veterans or active-duty military would lose all or part of two federal tax credits if key provisions expire as scheduled at the end of 2017.  Some 450,000 veteran and armed forces families with children would lose all or part of their Child Tax Credit; a similar number of veteran or active-duty military families would lose all or part of their Earned Income Tax Credit.  Click here for more.

States Can Stand Up for Veterans by Expanding Medicaid

November 10, 2014 at 12:37 pm

Roughly 215,000 veterans in 23 states are uninsured and denied Medicaid because their state has refused to take up health reform’s Medicaid expansion.  Half of them live in five states:  36,000 in Texas, 32,000 in Florida, 20,000 in Georgia, 17,000 in North Carolina, and 12,000 in Tennessee.

Most veterans get health coverage from their employer, but for those without access to job-based coverage, substantial gaps exist.  While some veterans receive coverage through the VA health system, not all qualify.

Health reform, however, has greatly expanded uninsured veterans’ access to health coverage.  Nearly 90 percent of non-elderly veterans who were uninsured before health reform would be eligible for Medicaid or subsidies to buy private coverage through the new insurance marketplaces, the Urban Institute projected in 2012 — if all states take up the Medicaid expansion.

Unfortunately, 23 states haven’t.  That’s left 215,000 of the nation’s poorest uninsured veterans in a coverage gap, where their income is too high for Medicaid under prior eligibility rules but too low for marketplace subsidies.

States that have expanded Medicaid are making the greatest progress in reducing the ranks of the uninsured, we’ve pointed out.  Meanwhile, states that haven’t taken up the expansion are denying health coverage for their poorest residents, including many uninsured men and women who have served our nation.

 

State Medicaid Spending Growing Slower in Expansion States Than Others

October 27, 2014 at 2:43 pm

States that have expanded Medicaid as part of health reform expect their share of Medicaid spending to grow more slowly this year than states that have not expanded, a new Kaiser Family Foundation report finds.  That’s yet more evidence that states are headed down divergent paths based on whether they have taken up the expansion.

The 28 states (including Washington, D.C.) that have expanded Medicaid or will expand it this fiscal year (2015) expect their Medicaid spending to grow by 4.4 percent this year, compared to 6.8 percent among non-expansion states, Kaiser’s annual survey finds (see graph).

What’s more, state Medicaid spending growth will actually slow in expansion states this year, down from 6.6 percent last year.  Meanwhile, non-expansion states expect a modest uptick in state spending growth from last year.

While benefiting from slower spending growth, expansion states are making substantial progress in reducing the ranks of the uninsured.  The uninsured rate among non-elderly adults has fallen by 38 percent in expansion states but only by 9 percent in non-expansion states, an Urban Institute survey found.  The fact that the federal government picks up the entire cost of newly eligible individuals under the expansion allows states to expand coverage while limiting their costs.

While the Kaiser report examined only state Medicaid budgets, it notes that expansion states also expect a more far-reaching positive impact on their overall finances:

States expanding Medicaid also typically cited net state budget savings beyond Medicaid.  States reported that expanded coverage through Medicaid could allow for reductions in state spending for services such as mental health, correctional health, state-funded programs for the uninsured and uncompensated care.