The purpose of this study is to compare the US states that have adopted the Affordable Care Act’s (ACA) Medicaid Expansion to the states that have not done so. The Medicaid Expansion makes people with incomes up to 138 percent of the federal poverty (FPL) line eligible for Medicaid. The US Supreme Court ruling in June 2012 made the Medicaid Expansion, originally intended to be nationwide, optional for states. To date, 37 states and the District of Columbia have implemented this Expansion.
We compare a group of states that adopted the Medicaid population, excluding a few states that had, pre-ACA, already covered most or all of this Expansion population, to those states that had not adopted this Expansion through the end of 2019. We compare these groups of states across the Medicaid Expansion timeframe that was available for analysis (typically 2014-2019). Some of the key components of our assessment included:
• Health Coverage — particularly impacts on the size of the uninsured population
• Medicaid Costs – overall and at the state and federal level
• Deaths in the under-65 population
• Employment Levels and Unemployment Rates
This study is an objective analysis of the observed impact of Medicaid Expansion on the number of uninsured, Medicaid costs to both states and the federal government, deaths, employment, hospitals’ financial situation, and other key outcomes. The intent is to help inform the states that have not yet implemented the Expansion about its likely impact, as well as to demonstrate for Expansion states the aggregated impacts that have occurred.
This edition of our 5 Slide Series coincides with today’s release of a new report, “Assessment of Medicaid Expansion’s Impacts.” The 5 Slide Series creates an opportunity for our staff team to contribute to the Medicaid industry outside the boundaries of our project work, and this report represents a more significant effort of that nature.
This edition assesses whether differences exist in overall economic performance that might help explain the Medicaid enrollment trend differences that were identified in our January 2019 edition of the Series. We have presented the unemployment rate progression from 2010 to 2017 by state, comparing aggregate unemployment rates across states that did and did not adopt Medicaid expansion.
This edition tracks the national Medicaid enrollment projection from January 2014 through September 2017, showing enrollment growth dynamics between the expansion and non-expansion population, and across states that adopted Medicaid expansion versus those electing not to do so.
Our November Edition of the 5 Slide Series focuses on the 2018 election results and conveys some of the potential implications of these results regarding Medicaid expansion.
The August edition quantifies Medicaid DSH payments, showing the progression of DSH spending in each state from 2013-2017. The key takeaway is that Medicaid DSH has not dropped at all across the expansion states since 2013, even though this was intended to occur as one of the mechanisms to help offset the Federal costs of Medicaid expansion.
Volume #42 of our Series identifies the number of state prison inmates in each Medicaid expansion state, and describes opportunities to deliver community re-entry care coordination support.
This edition provides data on Medicaid prescription drug usage and costs and trends from 2013 to 2015. Each data table shows national totals and subtotals for three groups of states: non-expansion states, initial Medicaid expansion states (those implementing Medicaid expansion in January 2014), and subsequent expansion states. The tables show all Medicaid-paid pharmacy volume, including prescriptions paid by Medicaid MCOs and those paid in the Medicaid fee-for-service setting. Tables differentiate pre-rebate and post-rebate spending.
This October edition of the Five Slide Series quantifies the monthly influx of the Medicaid expansion population through March of 2015. Expansion enrollment increased throughout the 15 month period in 14 of the 15 states reviewed.
This edition of the Five Slide Series estimates the amount each states’ residents are paying for the Medicaid expansion population’s coverage – whether or not their state is participating in the coverage program. In the aggregate, we estimate that an annual financial transfer of $17 billion is occurring from the residents of the non-expansion states to the residents of the expansion states. A state not yet participating in the expansion can move its residents from collectively being large-scale net losers to a large-scale net gainers by opting to participate.