Economics of the Medicaid Expansion
Robin Rudowitz
Associate Director, Kaiser Commission on Medicaid and the Uninsured
Bob...
Figure 1
Compared to the US, Florida has a higher uninsured rate.
42%
5%14%
17%
2%
20%
Florida
Employer
Individual
Medicai...
Figure 2
27%
25%
22%
22%
21%
20% 20% 19%
18% 18%
17% 17%
16% 16%
15% 15%
12%
9%
TX FL LA GA AR OK NC SC US MS WV KY AL TN ...
Figure 3
SOURCE: KCMU/Urban Institute analysis of 2011 American Community Survey
Florida accounts for 8% of the country’s ...
Figure 4
The ACA seeks to increase access to affordable health
coverage options, especially for adults.
Medicaid Coverage ...
Figure 5
The ACA Medicaid expansion fills current gaps in coverage.
*138% FPL = $16,105 for an individual and $27,310 for ...
Figure 6
The ACA modernizes the Medicaid application and
enrollment experience in all states.
ACA VisionPAST
Real-time
det...
Figure 7
100% 100% 100%
95% 94% 93% 90%
60% 60% 60% 60% 60% 60% 60%
2014 2015 2016 2017 2018 2019 2020 and
Beyond
Federal ...
Figure 8
The Medicaid expansion has coverage and fiscal
implications for states.
Increased State
Economic Activity
Increas...
Figure 9
Implementing the ACA Medicaid expansion will bring increased
payments to hospitals that could offset reductions i...
Figure 10
NOTES: Data as of March 26, 2014. *AR, IA and MI have approved waivers for Medicaid expansion (MI
plans to imple...
Figure 11
Nearly 764,000 poor nonelderly uninsured adults in Florida
will fall into the ACA coverage gap in 2014.
NOTE: Ex...
Figure 12
Other
Southern
States
33%
Georgia, 8%
Florida
16%
Texas
22%
Midwest
11%
Northeast
6%
West
4%
NOTE: Based on stat...
Figure 13
White,
42%
Black
28%
Hispanic
26%
Other
4%
Notes: Excludes legal immigrants who have been in the country for fiv...
Figure 14
• Gains in access and increased use of health care
– More likely to have usual place of care, better perceived a...
Figure 15
• Most states implementing the Medicaid expansion through State
Plan Amendment (SPA) using flexibility provided ...
Figure 16
Premium
Assistance
Premiums
Healthy
Behavior
Incentives
Benefit
Changes
Work
Requirements
Arkansas
(approved)
x
...
Figure 17
• Will there be movement in the legislature on the Medicaid expansion in
Florida?
• How well will new enrollment...
Upcoming SlideShare
Loading in …5
×

Economics of the Medicaid Expansion

451 views

Published on

Robin Rudowitz, Associate Director, Kaiser Commission on Medicaid and the Uninsured, discusses the financial implications of Medicaid expansion and the Affordable Care Act.

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
451
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
4
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Economics of the Medicaid Expansion

  1. 1. Economics of the Medicaid Expansion Robin Rudowitz Associate Director, Kaiser Commission on Medicaid and the Uninsured Bob Graham Center for Public Service Gainesville, Florida April 9, 2014
  2. 2. Figure 1 Compared to the US, Florida has a higher uninsured rate. 42% 5%14% 17% 2% 20% Florida Employer Individual Medicaid Medicare Other Public Uninsured 49% 5% 16% 13% 1% 16% United States NOTES: Data may not total to 100% due to rounding. Medicaid includes the Children’s Health Insurance Program (CHIP) and Other Public includes non-elderly Medicare and military-related insurance. SOURCE: KCMU/Urban Institute analysis of the 2011 and 2012 ASEC Supplement to the CPS.
  3. 3. Figure 2 27% 25% 22% 22% 21% 20% 20% 19% 18% 18% 17% 17% 16% 16% 15% 15% 12% 9% TX FL LA GA AR OK NC SC US MS WV KY AL TN VA MD DE DC SOURCE: KCMU/Urban Institute analysis of 2013 and 2012 ASEC Supplements to the CPS. Florida has the second highest rate of nonelderly uninsured in the South. Uninsured Rates among Nonelderly Southerners by State, 2011-2012 United States: 18% The South: 21%
  4. 4. Figure 3 SOURCE: KCMU/Urban Institute analysis of 2011 American Community Survey Florida accounts for 8% of the country’s uninsured at or below 138% FPL. 51% Total: 25.4 Million Nonelderly Uninsured ≤138% FPL by Location FLTXCA GA, IL, NY, NC Other States
  5. 5. Figure 4 The ACA seeks to increase access to affordable health coverage options, especially for adults. Medicaid Coverage For Low-Income Individuals Employer-Sponsored Coverage Marketplaces With Subsidies For Moderate Income Individuals Individual Mandate Health Insurance Market Reforms Universal Coverage
  6. 6. Figure 5 The ACA Medicaid expansion fills current gaps in coverage. *138% FPL = $16,105 for an individual and $27,310 for a family of three in 2014. Adults Elderly & Persons with Disabilities Parents Pregnant Women Children Extends to Adults ≤138% FPL* Medicaid Eligibility Today Medicaid Eligibility in 2014Limited to Specific Low-Income Groups Extends to Adults ≤138% FPL*
  7. 7. Figure 6 The ACA modernizes the Medicaid application and enrollment experience in all states. ACA VisionPAST Real-time determination Data Hub $ # Dear __, You are eligible for… Apply in person Multiple options to apply Provide paper documentation Electronic verification Wait for eligibility determination Medicaid CHIP Marketplace No Wrong Door to Coverage
  8. 8. Figure 7 100% 100% 100% 95% 94% 93% 90% 60% 60% 60% 60% 60% 60% 60% 2014 2015 2016 2017 2018 2019 2020 and Beyond Federal Share for Newly Eligible Traditional FMAP in FL The federal government will pay for the vast majority of costs to cover those newly eligible.
  9. 9. Figure 8 The Medicaid expansion has coverage and fiscal implications for states. Increased State Economic Activity Increased Provider Revenue Reduction in the Number of Uninsured ↓ Uncompensated Care Costs ↓ State-funded health programs (e.g. Mental health) Increased State Savings Federal + State Funds + ↑ Jobs and Revenues
  10. 10. Figure 9 Implementing the ACA Medicaid expansion will bring increased payments to hospitals that could offset reductions in DSH. 0.0% 10.0% 20.0% 30.0% 40.0% MA VT NY DC DE MN IA ME WA AK IL NM RI MD CT MI CA NE NJ HI KS WI OK NH PA ID TN UT MT MO VA WY TX SD IN LA CO KY NC WV SC NV AL OR OH AR GA MS ND FL For FL – 31% Increase or $33.6 billion NOTE: AZ is not included because analysis includes only FFS payments (and AZ has no FFS). Includes federal and state spending. Source: Urban Institute estimates prepared for the Kaiser Commission on Medicaid and the Uninsured, October 2012.
  11. 11. Figure 10 NOTES: Data as of March 26, 2014. *AR, IA and MI have approved waivers for Medicaid expansion (MI plans to implement Apr. 2014). IN and PA have pending waivers for alternative Medicaid expansions. WI amended its Medicaid program to cover adults up to 100% FPL, but did not adopt the expansion. NH has passed legislation approving the Medicaid expansion to begin in July 2014. SOURCES: Based on data from CMS here, and KCMU analysis of more recent state legislation, public statements mad by Governors, or issuance of waiver proposal. Due to the Supreme Court ruling, states effectively have the option to implement the Medicaid expansion. WY WI* WV WA VA VT UT TX TN SD SC RI PA* OR OK OH ND NC NY NM NJ NH* NV NE MT MO MS MN MI* MA MD ME LA KYKS IA* IN*IL ID HI GA FL DC DE CT CO CA AR*AZ AK AL Implementing Expansion in 2014 (27 States including DC) Open Debate (5 States) Not Moving Forward at this Time (19 States)
  12. 12. Figure 11 Nearly 764,000 poor nonelderly uninsured adults in Florida will fall into the ACA coverage gap in 2014. NOTE: Excludes undocumented immigrants and legal immigrants who have been in the US for <5 years. SOURCE: KFF analysis of March 2012 and 2013 CPS and 2014 Medicaid MAGI eligibility levels. 763,890 UNINSURED ADULTS 35% FPL Parents ($6,836 for a family of 3) Medicaid Eligibility Limits in Florida 0% FPL Childless Adults 100% FPL ($11,490 for an individual) 400% FPL ($45,960 for an individual)
  13. 13. Figure 12 Other Southern States 33% Georgia, 8% Florida 16% Texas 22% Midwest 11% Northeast 6% West 4% NOTE: Based on state Medicaid expansion decisions as of March 2014. Excludes undocumented immigrants. SOURCE: Kaiser Family Foundation analysis based on 2014 Medicaid eligibility levels and 2012-2013 Current Population Survey. 8 in 10 poor uninsured adults in the coverage gap live in the South with 16% in Florida. Total: 4.8 Million Adults in the Coverage Gap South 79% (3.8 M)
  14. 14. Figure 13 White, 42% Black 28% Hispanic 26% Other 4% Notes: Excludes legal immigrants who have been in the country for five years or less and immigrants who are undocumented. The poverty level for a family of three in 2013 is $19,530. Totals may not sum to 100% due to rounding. Source: Kaiser Family Foundation analysis based on 2014 Medicaid eligibility levels and 2012-2013 Current Population Survey. See technical appendices available at http://www.kff.org/health- reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/ for more detail. 19-24 years, 24% 25-34 years 24% 35-54 years 36% 55-64 years 16% In Florida, demographic characteristics of adults in the coverage gap largely mirror those of poor uninsured adults. Total = 763,890 in the Coverage Gap Distribution By Age: Distribution By Race/Ethnicity: Parents, 23% Childless Adults 77% Parent Status:
  15. 15. Figure 14 • Gains in access and increased use of health care – More likely to have usual place of care, better perceived access – Increased use of preventive care, physician services, Rx drugs, hospital admissions – Increased emergency department use Recent findings from an Oregon study point to benefits of Medicaid coverage. • Reduced depression, mixed results on physical health – Reduced rates of depression, but no change in blood pressure, cholesterol, or blood sugar – Self-reported improvements in physical and mental health, overall well-being • Increased financial security – Near elimination of catastrophic medical spending – Reductions in other measures of financial strain • Questions – Longer-run impact of improved access and delivery system reforms on outcomes Figure 17
  16. 16. Figure 15 • Most states implementing the Medicaid expansion through State Plan Amendment (SPA) using flexibility provided in the law • Limited number of states are seeking waivers for alternative approaches to implement the ACA • 1115 Waiver authority is for demonstrations that promote the objectives of the Medicaid program – Authorizes the HHS Secretary to waive certain federal Medicaid requirements and provide federal matching funds for costs that would not otherwise be matched – Section 1115 waivers are required to be budget neutral to the federal government – Waiver approval involves negotiations between a state and HHS – The ACA requires transparency and meaningful opportunities for public input in the 1115 waiver process Some states are exploring alternative approaches to implementing the Medicaid expansion.
  17. 17. Figure 16 Premium Assistance Premiums Healthy Behavior Incentives Benefit Changes Work Requirements Arkansas (approved) x Iowa (approved) x x x x Michigan (approved) x x Pennsylvania (proposed) x x x x x Key themes have emerged in alternative approaches to the Medicaid expansion. Key Themes in Recent ACA Expansion Waivers
  18. 18. Figure 17 • Will there be movement in the legislature on the Medicaid expansion in Florida? • How well will new enrollment systems work and how well will systems be coordinated across health programs? • What will happen to individuals in the coverage gap if Florida does not implement the expansion? • What can Florida learn from other states that are moving forward? – How are alternative models to implement the expansion working? – What is the effect on state revenues? – Implications for providers? – Implications for broader state economy? What to look for going forward….

×