Medicaid: It’s Role Today and Under the Affordable Care Act. JAMA, August 22/29, 2012

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  • 1. Health Insurance Coverage of the Nonelderly, 2010 56.2% Employer- Sponsored Insurance 18.5% Uninsured 19.8% Medicaid* 5.5% Private Non-Group 266 M Nonelderly* Medicaid also includes other public programs: CHIP, other state programs, Medicare and military-relatedcoverage. Numbers may not sum to 100 due to rounding.SOURCE: KCMU/Urban Institute analysis of 2011 ASEC Supplement to the CPS.
  • 2. Medicaid plays a critical role for selected populations Percent with Medicaid coverage: All Nonelderly Individuals Poor 43% Near Poor 26% Families All Children 34% Low-Income Children 59% Low-Income Adults 22% Births (Pregnant Women) 45% Aged & Disabled Medicare Beneficiaries 20% People Living with HIV/AIDS 47% Nursing Home Residents 70%SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute analysis of ASEC Supplementto the CPS; Birth data from Maternal and Child Health Update: States Increase Eligibility for Childrens Healthin 2007, National Governors Association, 2008; Medicare data from USDHHS.
  • 3. Medicaid Facilitates Access to Care for Nonelderly Adults Employer/Other Private Medicaid/Other Public Uninsured 53% 30% 26% 12% 10% 10% 10% 7% 4% No Usual Source Postponed Seeking Care Went Without Needed Care of Care Due to Cost Due to CostIn past 12 months.Respondents who said usual source of care was the emergency room were included among those nothaving a usual source of care. All differences between the uninsured and the two insurance groups arestatistically significant (p<0.05).SOURCE: KCMU analysis of 2011 NHIS data.
  • 4. The elderly and disabled account for the majority of Medicaid spending Disabled 15% Elderly 10% Disabled 43% Adults 26% Elderly 23% Adults 14% Children 49% Children 21% Enrollees Expenditures FY 2009 = 62.6 million FY 2009 = $346.5 billionNOTE: Percentages may not sum to 100 due to rounding.SOURCE: KCMU/Urban Institute estimates based on data from FY 2009 MSIS and CMS-64, 2012. MSIS FY 2008 data wereused for MA, PA, UT, and WI, but adjusted to 2009 CMS-64.
  • 5. Medicaid spending growth per capita was slowerthan private health care spending from 2007 to 2010. 5.5% 3.4% 3.3% 3.4% 2.5% 1.1% 0.9% Medicaid Medicaid Medicaid NHE per Private Medical care GDP per services per acute care LTC per capita health CPI capita enrollee per enrollee enrollee insuranceNote: Acute Care includes payments to managed care plans.Source: Medicaid estimates from Urban Institute analysis of data from the Medicaid Statistical Information System (MSIS), Centers forMedicare and Medicaid Services (CMS) Form 64, and Kaiser Commission and Health Management Associates data, 2011. Private healthinsurance and GDP data from Centers for Medicare & Medicaid Services Office of the Actuary, National Health Statistics Group, 2011.Medical care CPI from the Bureau of Labor Statistics, Consumer Price Index Detail Report Tables, 2011.
  • 6. Expanding Coverage Under the Affordable Care Act Federal Poverty Level 10% 400%+ 56% Employer- Sponsored 37% 139-399% Insurance 18% (Subsidies) Uninsured 20% 54% <139% Medicaid* (Medicaid) 6% Private Non- Group 266 M Nonelderly 49.1 M Uninsured* Medicaid also includes other public programs: CHIP, other state programs, Medicare and military-relatedcoverage. The federal poverty level for a family of three in 2012 is $19,090. Numbers may not add to 100 dueto rounding.SOURCE: KCMU/Urban Institute analysis of 2011 ASEC Supplement to the CPS.
  • 7. Uninsured Adults By Income, 2010 <139% 139% FPL FPL+ (Medicaid) 52% (21.6 M) 48% (19.6 M) Total Uninsured Nonelderly Adults= 41.2 MillionAdults includes all individuals aged 19-64. The federal poverty level for a family of three in 2010 was$18,210. Percentages may not sum to 100 due to rounding.SOURCE: KCMU/Urban Institute analysis of March 2011 Current Population Survey, Annual Social andEconomic Supplement.
  • 8. The Federal Government Will Pay for the Large Majority of Medicaid Coverage Costs in Health Reform Federal State: 95.4% 4.5% $443.5 Billion $21.1 Billion Total: $464.7 billion over 2014-2019Note: Adults less than 133% FPL under standard participation scenario.SOURCE: Analysis for KCMU by The Urban Institute, May 2010