States Reluctant to Expand the Affordable Care Act’s Medicaid. Information Bulletin # 362 (7/2012) The Supreme Court has held that the Affordable Care Act is constitutional. It also ruled that Congress cannot “coerce” States to expand the Medicaid eligibility via the ACA to cover people whose incomes are less than 133% of the federal poverty level (about $14,856 for a single person and about $30,657 for a family of four). The purpose of this Information Bulletin is to suggest some arguments advocates can use, especially if your State is hinting that it may not expand Medicaid to cover low-income individuals and families. First, obviously, we bet that some of the posturing States are presently taking is related to the presidential election. If Obama is re-elected, then the reality might sink in and your State might quietly accept the expansion. If Romney is elected, your State might be fantasizing that the ACA may be amended. Second, it’s important that advocates use the State-specific data to make public arguments regarding why your State would be fiscally irresponsible not to expand its Medicaid program. Third, since the ACA phases out special MA reimbursements for “disproportionate share” hospitals, many hospitals, which in the past received extra reimbursements because they treated large numbers of low-income patients, will lose these MA funds! Yes, one natural ally in your State are the hospitals and state-wide Hospital Association. Fourth, this issue presents a natural potential for a “My Medicare Matters” alliance between the disability/elderly advocates and the low-income groups/AARPs/AAAs in your community. Call them up. Here’s some national data which may be helpful. • Between 2014 and 2022, the federal government will pay 93% of the total Medicaid expansion costs. • The federal government will spend $931 billion for the Medicaid expansion and the States about $73 billion between 2014 and 2022. • States currently spend $2.6 trillion on Medicaid without the ACA expansion. The additional $73 billion to cover the 133% expansion results on average in only a 2.8% increase on what States would have otherwise have spent. • The 2.8% is probably actually larger than what States will spend because it does not reflect increased savings States will realize because of other provisions in the ACA which reduce some existing costs, e.g., state and local costs for hospital care for the uninsured. • States savings from uncompensated care may fully cover States’ increases from the 133% Medicaid expansion. Here are 12 States where the Governors have said either they will not implement the Medicaid expansion or are on the fence. We use a 2014-2019 timeframe. • Alabama has 351,567 low-income people (133% of FPL) who will be denied coverage and will therefore lose $10,305 million federal dollars by not spending $470 million of State funds between 2014-19. If Alabama enrolled these people, the State’s share of Medicaid spending would increase by only 3.6%. • Florida has 951,622 low-income people (133% of FPL) who will be denied coverage and will therefore lose $20,050 million federal dollars by not spending $1,233 million of State funds between 2014-19. If Florida enrolled these people, the State’s share of Medicaid spending would increase by only 1.9%. • Louisiana has 366,318 low-income people (133% of FPL) who will be denied coverage and will therefore lose $7.273 million federal dollars by not spending $337 million of State funds between 2014-19. If Louisiana enrolled these people, the State’s share of Medicaid spending would increase by only 1.7%. • Kansas has 143,445 low-income people (133% of FPL) who will be denied coverage and will therefore lose $3,477 million federal dollars by not spending $166 million of State funds between 2014-19. If Kansas enrolled these people, the State’s share of Medicaid spending would increase by only 1.7%. • Kentucky has 329,000 low-income people (133% of FPL) who will be denied coverage and will therefore lose $11,878 million federal dollars by not spending $515 million of State funds between 2014-19. If Kentucky enrolled these people, the State’s share of Medicaid spending would increase by only 3.5%. • Maine has 43,468 low-income people (133% of FPL) who will be denied coverage and will therefore lose $1,857 million federal dollars by not NOT spending $ -118 million of State funds between 2014-19. If Maine enrolled these people, the State Medicaid spending would actually DECREASE by 1.5%. • Missouri has 307,872 low-income people (133% of FPL) who will be denied coverage and will therefore lose $8,395 million federal dollars by not spending $431 million of State funds between 2014-19. If Florida enrolled these people, the State’s share of Medicaid spending would increase by only 1.7%. • North Dakota has 28,864 low-income people (133% of FPL) who will be denied coverage and will therefore lose $595 million federal dollars by not spending $32 million of State funds between 2014-19. If North Dakota enrolled these people, the State’s share of Medicaid spending would increase by only 1.4%. • Ohio has 667,376 low-income people (133% of FPL) who will be denied coverage and will therefore lose $17,130 million federal dollars by not spending $830 million of State funds between 2014-19. If Ohio enrolled these people, the State’s share of Medicaid spending would increase by only 1.6%. • South Carolina has 344,109 low-income people (133% of FPL) who will be denied coverage and will therefore lose $10,919 million federal dollars by not spending $470 million of State funds between 2014-19. If South Carolina enrolled these people, the State’s share of Medicaid spending would increase by only 3.6%. • Texas has 1,798,314 low-income people (133% of FPL) who will be denied coverage and will therefore lose $52,537 million federal dollars by not spending $2,619 million of State funds between 2014-19. If Texas enrolled these people, the State’s share of Medicaid spending would increase by only 3.0%. • Wisconsin has 205,987 low-income people (133% of FPL) who will be denied coverage and therefore lose $4,252 million federal dollars by not spending $205 million of State funds between 2014-19. If Wisconsin enrolled these people, State’s share of Medicaid spending would increase by only 0.9%. The data for the 12 States are from the Kaiser Commission’s “Medicaid Coverage and Spending in Health Reform: National and State-by-State Results for Adults at or Below 133% FPL” at Table 1. The national data are from the Center on Budget and Policy Priorities, “Federal Government Will Pick Up Nearly All Costs of Health Reform’s Medicaid Expansion.” If your State is not one of the 12 listed in this Information Bulletin, Google the above Kaiser report. If you still have difficulty and want to know, email me at address below. Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.