Thursday, June 10, 2021

Medicaid Expansion Update: What is its Impact on Uninsured Rates?


























In the early days of this blog, I wrote extensively on how states were rolling out Medicaid expansion under the Affordable Care Act (aka Obamacare or ACA).  The 2012 Supreme Court decision that upheld the ACA made Medicaid expansion optional for the states.  This expansion allows states to raise the income eligibility level from 100% of the federal poverty level to 133%.

The above map shows that 12 states still refuse to expand Medicaid 11 years after the ACA was passed while 31 states have expanded and 8 states have used different methods to expand.  The map below shows where each state stood on expansion in 2012.  





























The census bureau has 2018 as the most recent year where estimates of the uninsured are available.  Thus, to assess the impact of Medicaid expansion, I will compare uninsured rates at the state level between 2010 (the year the ACA was passed) and 2018.  The states will be grouped by whether they refused to expand it in 2018 (19 states), implemented expansion by 2018 (26 states), or implemented it with other methods (6 states).


Expanded by 2018

2010

2018

Change in %

N

M

SD

M

SD

none

19

18.6%

4.2%

12.5%

3.0%

6.1%

yes

26

14.6%

4.5%

7.6%

2.5%

7.0%

modified

6

16.0%

3.3%

8.7%

2.4%

7.4%


The table above shows the mean uninsured rates for each group of states with respect to Medicaid expansion.  There was a significant decrease in the uninsured in all three groups due to the implementation of other parts of the ACA.  The states that did not expand Medicaid had higher baseline mean or average uninsured rates at 18.6% compared to 14.6% for those that expanded traditionally and 16.0% for those who expanded using modified methods by 2018.  The uninsured rates for 2018 showed a wider gap in uninsured rates between states that did not expand (12.5%) and the other two groups (7.6% and 8.7% respectively). The standard deviation or SD's show less variability in uninsured rates in all three groups by 2018.

These numbers show that the ACA is having an impact on uninsured rates throughout the U.S.  Medicaid expansion increases this effect in states that have implemented it.  There is still a group of uninsured even in states that have implemented expansion.  A much harder number to measure is the number of uninsured individuals in then U.S.  Further steps will be needed to reach universal coverage.

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2 comments:

  1. Random notes:

    1. Of the 12 current non-Medicaid-expansion states, 10 were part of the Union on the eve of the Civil War. Of these 10, ** 8 ** were SLAVE STATES. Draw your own conclusions.

    2. I live in Texas, a non-expansion state. Mainline progressive groups are trumpeting Medicaid expansion, a worthy cause -- but ignoring the need for universal healthcare. Texas has 5 million uninsured. Expansion will cover about 1 million. The other 4 million? Ignored. Essentially thrown under the bus by not mentioning the need for universal care.

    3. "Thrown under the bus" is a metaphor but has a specific lethal meaning. Statistical studies have shown that for each 1 million people who lack coverage, approx 1,250 will die each year for this reason alone. (i.e., annual mortality increases by 1 in 800.) So, ignoring the "other" 4M people who won't benefit from TX Medicaid epansion is like saying, "We're fine with condemning 5,000 people to death every year in Texas." Think of it as CSI *with* dead bodies.

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