New data: Medicaid expansion providing big benefits to states that have opted for it

In a new post this afternoon, Jesse Cross-Call at the Center on Budget and Policy Priorities reports the latest confirmation that North Carolina is shooting itself in the foot with its stubborn and shortsighted refusal to expand Medicaid to hundreds of thousands of uninsured people under the Affordable Care Act.

As a growing number of reports increasingly make clear, a state’s decision whether to expand Medicaid as part of health reform has real-life effects on its residents and its businesses.  In the 26 states and the District of Columbia that have expanded Medicaid (see map), the positive benefits are already playing out.  Here’s some of the latest information:

  • Hospitals are providing less uncompensated care.  In Arizona, hospitals reported that the Medicaid expansion is the chief reason for a 30 percent decline in the amount of uncompensated care they have provided so far this year, compared with a year ago.  The Colorado Hospital Association found a similar decline in charity care through April when it surveyed hospitals in 15 states that have expanded Medicaid and 15 that have not.
  • Medicaid expansion is driving large gains in health coverage.  A survey conducted by the Urban Institute finds that while the uninsurance rate is dropping across the country, states that have expanded Medicaid have seen a drop in the percentage of non-elderly adults who are uninsured by more than one-third — a 37.7 decline — while the uninsured rate fell by only 9 percent among states that haven’t expanded.  A survey from the Commonwealth Fund found a similar trend.

States can opt in to the Medicaid expansion at any time, allowing them to extend coverage to millions with the federal government picking up all of the cost of the expansion through 2016 (and nearly all of the cost in the years after), as we have written.  New Hampshire recently started accepting applications for its expansion, with coverage first available on August 15.

But states that refuse to expand leave a coverage gap, where people below the federal poverty line have income too high for Medicaid under prior eligibility rules but too low to qualify for federal subsidies to purchase coverage through the marketplaces.  This means we’re likely to see more stories as in Tennessee where, due to the coverage gap, a couple separated so the wife’s income would be low enough to maintain her Medicaid coverage.


  1. Alex

    July 17, 2014 at 2:19 pm

    Judging by this article, not going so well in Chicago :

    “Chicago’s public health system is facing a massive $67 million shortfall after an early adoption of Obamacare’s Medicaid expansion cost much more than expected, Crain’s Chicago Business reports.
    Cook County, which encompasses Chicago and its surrounding suburbs, made a deal with the Obama administration to get an early start on the health care law’s Medicaid expansion in 2012.
    But the resulting program, CountyCare, is costing millions more than original projections. The prototype Medicaid expansion lost Cook County $21 million in the first six months of operation — that’s expected to balloon to $63.5 million by November 30, according to the Chicago Tribune.

    Read more: http://dailycaller.com/2014/07/14/chicago-faces-67-million-shortfall-after-obamacares-medicaid-expansion-busts-budget/#ixzz37kcz4Kog

  2. ML

    July 17, 2014 at 4:44 pm

    Chicago is city which has it’s own problems.

  3. Alex

    July 17, 2014 at 4:58 pm

    Unfortunately, Chicago is not by itself ML. Many of our cities are broke and look like third world countries in many parts of them.

  4. ML

    July 18, 2014 at 2:12 pm

    But your point was that the ACA is the cause. I agree many cities are in shambles across the nation, however, the reasons for the poor conditions have nothing to do with the ACA.

  5. Pertains!

    July 18, 2014 at 3:48 pm

    The ACA is just the tip of the iceberg they hate they lost the White House to someone that has a different skin color…..
    The people we elected (esp the Senate) have a deep dislike for for the poor which includes elderly, disabled, minorities and unfortunately NC children.
    It is truly a shame we placed NC in the hands of a group of entitled, heartless individuals.

  6. LayintheSmakDown

    July 19, 2014 at 10:08 am

    So 27 states will be crying once the feds keep ratcheting back the percentage given back to the states. They are on the brink of disaster and don’t know it.

  7. ML

    July 21, 2014 at 9:14 am

    Wrong again LSD. Thanks for the hyperbole but the brink is not eminent nor will the Feds ratchet back anymore than 90%. That is the fed will always fund 90% of Medicaid bc it’s the law.

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