Commentary

Medicaid expansion: the state-by-state picture

Health numbersThe legislative debate over Medicaid reform over the last two weeks once again revealed the Senate’s misplaced priorities – profits over people. The health of North Carolinians was not only compromised by pushing reform that employs commercial insurers and dismantling Community Care North Carolina (CCNC), but also by failing to expanding Medicaid to the half million people in the Coverage Gap. It is surprising that for a governing body that focuses most of its efforts on profits, the Senate fails to recognize the economic benefits of Medicaid expansion.

Unfortunately, many conservative policymakers agree with Sen. Harry Brown when he stated, “Every state that has expanded Medicaid has created a financial problem in their state budgets” during the expansion debate. Black and white statements like his fail to present the complete and complex picture of each state’s expansion experience. To present a more accurate picture, the Health Access Coalition created a chart outlining the successes and challenges for each of the 30 states and DC that has expanded Medicaid. The chart also provides information on whether the state used a waiver to expand Medicaid. Waivers allow states to tailor Medicaid expansion to meet specific state needs and even include Medicaid reform.

After reviewing this chart, it becomes clear that the biggest challenge states have experienced is providing health coverage to more people than expected – being able to reduce a state’s uninsured rate to 5 percent should be noted as a success! Further, “over-enrollment” proves that need for health care is great and that the long term benefits will be even greater. However, expansion is complex and along with increased enrollment comes budget concerns for the years when the federal match for expansion lowers from 100 percent to 90 percent starting in 2020. Even though states have to reassess their budgets and establish tools to cover Medicaid costs such as hospital assessments, there are several states that have experienced an economic boost. For example, Arkansas reports a combined savings of $120 million between fiscal years 2014 and 2015 due to expansion. Arizona has also gained of over $30 million in new revenue. Colorado has created 20,000 jobs since Medicaid expansion. One county in Illinois has seen a decrease of $158 million in costs associated with providing care to people without health coverage. Other states like New Hampshire are seeing reduced use of emergency rooms as health services are finally being provided to individual that face many barriers to health care for health concerns such as substance use and mental health.

Unlike Sen. Brown’s sales tax distribution plan, Medicaid expansion will have economic benefits for all 100 counties in North Carolina. Sen. Brown’s district, District 6, includes Jones and Onlsow counties. Failing to expand Medicaid by 2016 will cost Jones County $8.4 million less in business activity, $5.6 million less growth to the county’s economy, and $155.8 thousand less in tax revenue between 2016 and 2020. In Onlsow County, there will be $53 million less to the county’s economy, $77.3 million less in county business activity, and $292.9 thousand less in county tax revenue between 2016 and 2020 without expanding Medicaid. The most important benefit to these counties is that over 5,000 people will gain access to health care, but just in case North Carolina’s health benefits aren’t convincing, expansion will allow for $21 billion in federal funds to enter North Carolina.

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