Friday, October 2, 2015

Drop of Uninsured and Medicaid Expansion

ObamaCare officials boast that 9.9 million people have signed up for health exchange plans. What they fail to mention is that during that same period 12 million more citizens have enrolled in Medicaid. Medicaid , not health exchange plans, are the largest contributor to reducing the rate of uninsured Americans, which has gone from about 16.0% in 2010 when ObamaCare passed to about 10 % today.

The health law allows low-income people making less than, 138% of poverty, $16,245 for individuals, to qualify for Medicaid. This has several beneficial effects – it reduces the number of uinsured, now officially said to be 10.4% of the U.S population , it decreases the “uncompensated care” bills for hospitals by $74 billion, and it covers 100% of Medicaid coverage through 2016. After 2016, the federal share of Medicaid money for the states goes down to 95% in 2017, 94% in 2018, 93% in 2019, and 90% in 2020 and thereafter.

Thirty states and D.C. have taken advantage of this federal offer. Other states have either refused Medicare expansion or are considering it. For the nation as a whole, in 2014, 54 million were in Medicare and 70 million were in Medicaid or CHIP. By 2020 100 million may be in Medicaid. Medicaid beneficiaries include the disabled, the elderly, adults with low incomes, in children. By 2020 projections indicate as much as half of CMS expenditure may be in Medicaid. The current cost for each Medicaid beneficiary is about $6500.

Twenty states, mostly with Republican governors, are resisting Medicaid expansion. Why? Federal Medicaid money is “free.”
Well, not exactly. With “free” money, the federal government calls the shots, you lose control, and you can’t manage your own programs. The costs are so far about $1000 more per recipient than expected, perhaps because of pent-up demands among the sick who waited for government coverage. Emergency room costs are up, 5.6% in expansion states compared to 1.8% in non-expansion. To prepare for the Medicaid onslaught, states are building 950 new community health centers at the cost of #11 billion. The 5% transfer of costs from Washington to the states in 2015 can amount to a lot of money in cost-strapped states where Medicaid is currently their biggest single budget item. In California, 3 million more people enrolled in Medicaid than expected In Washington State, for example, where enrollees went from 539,000 from 245,000 in 2015, the cost of covering 284,000 extra Medicaid recipients would be $218 million mounting to $43.7 million by 2012. And then there’s the access problem, only half of doctors accept Medicaid patients because of low payments and the hassle factor.

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