The Center's work on 'Medicaid' Issues


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.

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.

Reaching More Needy Americans

November 26, 2014 at 12:20 pm

We’ve noted this Thanksgiving week that the safety net helps millions of Americans avert hardship and meet basic needs like food and housing.  Unfortunately, many eligible people miss out on needed help.  At a time of year when many Americans make a special effort to help the less fortunate, states and localities can redouble their efforts to connect these powerful programs to vulnerable friends and neighbors.

One important area needing attention is reaching people eligible for both SNAP (formerly food stamps) and Medicaid.  In four of the five states that Urban Institute researchers examined, only about two-thirds of children and adults who were eligible for both programs actually received both (see graph).  The rates were even lower for adults: in three of the five states, fewer than 60 percent of eligible adults received both.

The study recommends that states simplify application procedures and do more to inform eligible people about these benefits.

Changes like these can have a big impact.  Many states have made intensive efforts in recent years to increase SNAP participation among eligible people, such as by expanding outreach and reforming policies that discourage participation, particularly among working families.  (Those policies include requiring recipients to go to SNAP offices every 90 days to reapply and imposing unnecessary paperwork.)  States have streamlined administrative processes while maintaining high payment accuracy.

These activities boosted SNAP’s national participation rate from 54 percent to 83 percent between 2002 and 2012.  These efforts, however, have been within SNAP and don’t always ensure that eligible people get both SNAP and other critical supports, like Medicaid.  The relatively low joint participation rate for Medicaid and SNAP suggests that states can do much better to enroll people who qualify for both programs.

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.