END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

Medicaid Expansion

*(OK, Maine is a lock...except that GOP Gov. LePage is apparently still being an utter jackass about implementing it, while Virginia is still kind of iffy...see below...)

UPDATE 11/8/17: Maine voters approve Medicaid expansion

Maine voters on Tuesday decided to expand Medicaid to cover more low-income adults, becoming the first state to do so through a referendum.

Support for the ballot measure was up by more than 18 points with 64 percent of precincts reporting about 10 p.m. when it was called by NBC affiliate WCSH and The Associated Press.

The results in Maine, one of 19 states that rejected Medicaid expansion under the Affordable Care Act, comes as other Republican-led states like Utah and Idaho eye similar ballot measures.

Advocates of Medicaid expansion in Maine successfully petitioned the state to include a question on this year’s ballot following several failed legislative efforts to expand the program.

Here's the latest enrollment data from the Louisiana Department of Health.

I've embedded screen shots below, but there's various interactive stuff you can do at the site itself; LA did a very nice job, I'd love it if every state put up a similar "dashboard" style website.

In short:

  • 434,594 Louisianans enrolled in Medicaid via ACA expansion
  • 126,229 have received preventative care
  • 22,058 women have received breast cancer screenings
    • 225 women have been diagnosed with breast cancer as a result of ACA Medicaid expansion
  • 13,994 adults have received a colon cancer screening
    • 4,337 have averted colon cancer by having polyps removed
    • 199 have been diagnosed with colon cancer thanks to ACA Medicaid expansion
  • 3,774 have been diagnosed with diabetes
  • 9,575 have been diagnosed with hypertension
  • 32,912 are receiving outpatient mental health services
  • 6,025 are receiving inpatient mental health services
  • 5,559 are receiving outpatient substance abuse services
  • 6,026 are receiving residential substance abuse services

Not the highest-profile ACA/healthcare story in the world, but Wyoming almost never makes the news, and this is especially noteworthy given the state, the Governor and the GOP having total control over the federal government:

As health care debate simmers, Mead laments lack of Medicaid expansion in Wyoming

Gov. Matt Mead lamented the $100 million that Wyoming left on the table by choosing not to expand Medicaid, and he expressed concern for the state’s hospitals while discussing health care with the Star-Tribune recently.

Mead echoed some of the fears that many Wyoming hospital officials have expressed for months: that congressional proposals to overhaul the health care system may have negative effects on facilities here and that the state has suffered because it chose not to allow more people to qualify for Medicaid.

“The idea that we did not accept Medicaid expansion and things are going to be good just hasn’t turned out,” he said.

As regular readers know, I've been a bit obsessive about tracking down and breaking out ACA Medicaid expansion enrollee numbers. This is more difficult than it sounds, because most Medicaid reports lump expansion enrollees in with the other ~58 million or so Medicaid enrollees; only a handful of states issue separate reports of the expansion-specific population on a regular basis.

Back in late November, I cobbled together the data as best as I could and came up with a total of roughly 11.3 million people nationally. However, that included a lot of 2-year old data and rough estimates.

A couple of weeks later, I stumbled upon a detailed analysis from an anti-ACA financial watchdog organization, the Foundation for Government Accountability, which provided hard numbers and confirmable data source links which included more recent numbers for many states. This brought the total up to over 12.3 million.

Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.

Back on February 28th I noted that ACA Medicaid expansion enrollment across three states (Michigan, Louisiana and Pennsylvania) had grown by about 35,000 people since mid-January, to 667K, 406K and 716K people respectively.

Today, a month later, I decided to take another look at all three states, along with Minnesota (which I forgot to check last month). Sure enough, enrollment has continued to grow in all four, albeit at a slower pace:

Over the past month or so, I've been tallying up the number of people who would lose their healthcare coverage if and when the GOP actually does proceed with repealing the Affordable Care Act, breaking the totals out by both County and Congressional District in every state.

While this project has received high praise as a useful resource, one problem with it is that the numbers aren't static--between the high churn rate of the individual market and Medicaid, as well as the fact there's no limited enrollment period for Medicaid (you can sign up year-round), the enrollment figures are constantly changing.

Case in point: As of the beginning of January, roughly 640,000 Michiganders were enrolled in "Healthy Michigan", our name for ACA Medicaid expansion. By the end of January, that number had increased to just over 646,000.

 

For the most part, Republican Michigan Governor Rick Snyder has taken a fairly hands-off approach when it comes to both the Affordable Care Act and Donald Trump. He pushed for both Medicaid expansion and a state-based ACA exchange, but while he managed to get the former through the GOP-controlled state legislature (albeit 3 months late and with a few conservative trimmings), he failed on the latter front, and pretty much shrugged it off after that. Since then, Michigan's implementation of ACA Medicaid expansion has quietly been pretty damned successful, with 646,000 Michiganders (strike that...it's now up to 666,000!) enrolled in the program...over 6.5% of the entire state's population. Beyond that, however, Snyder has been fairly quiet about the ACA overall to my knowledge.

The last official ACA Medicaid expansion enrollment number I have recorded for Indiana (via their modified "Healthy Indiana 2.0" program) was 290,000 people way back in July 2015. At the time, the maximum potential HIP 2.0 enrollment total was 680,000 Hoosiers, made up of 350,000 newly covered plus another 330,000 being transferred over from the HIP 1.0 program.

This NPR article from a couple of weeks ago states that as of January, "the Healthy Indiana Plan that he established in 2015 as the state's governor has brought Medicaid coverage to more than 350,000 people." However, that number is a bit confusing given that they were also supposedly transferring the other 330K over from the other program as well. I'm not sure if 350K refers to total HIP 2.0 enrollment or only those who were previously uninsured.

I haven't posted an update on Pennsylvania's implementation of the ACA's Medicaid Expansion provision since last May, when it stood at around 625,000 enrollees.

Just moments ago, PA Governor Tom Wolf announced that enrollment has now broken the 700,000 milestone:

Over 700,000 Additional Pennsylvanians Enrolled in Governor Wolf’s Medicaid Expansion Plan
February 02, 2017

Harrisburg, PA – In February of 2015, Governor Wolf expanded Medicaid to ensure that Pennsylvanians can receive affordable, straightforward, accessible healthcare without unnecessary delays and confusion. Today, Governor Wolf announced that over 700,000 Pennsylvanians have enrolled in HealthChoices, Pennsylvania’s mandatory managed care Medicaid program, since expansion occurred two years ago. U.S. Census data shows that the commonwealth’s uninsured rate has dropped from 10.2 percent in 2010 to 6.4 percent in 2015.

OK, this appears to be quickly turning into my next project thing. The methodology here is pretty much the same as the other states; the only major difference is that while I do know the total Medicaid enrollment for each county (as of December 2016), I don't have that broken out between traditional and expanded Medicaid. Fortunately, I have a hard state-wide number for that: Around 398,000, or roughly 20.8% of the state-wide total. I've therefore multiplied each county number by 20.8% to get a rough estimate of the ACA expansion tally for each.

Like Texas, I'm also no longer expecting Arizona to beat last year's Open Enrollment total by much. Assuming 209K QHP selections, there should be around 125K indy market enrollees and 399K Medicaid expansion enrollees who'll be in a world of hurt post-repeal, or roughly 524,000 altogether.

(sigh) OK, after doing this for Michigan earlier today, I said that I wasn't gonna do this for every state, and I'm not...but the irony is that the 19 non-expansion states are actually easier to compile this data for than the expansion states...because you can't rip away healthcare from someone you never provided it to in the first place. Anyway, someone requested that I do a county-level estimate of how many people would likely lose their healthcare coverage in Texas under a full repeal of the Affordable Care Act, so here it is.

Regular readers (and Twitter followers) know that for the past month I've been heavily pushing my state-by-state analysis projecting how many people I expect to lose their healthcare coverage if/when the Republican-held Congress follows through on their promise to repeal the Affordable Care Act. As noted in that post and the various links within it, part of the projection is very specific and confirmed (ie, the exact number of Medicaid expansion enrollees), while the rest is more speculative. For one thing, I don't know exactly how many people will have enrolled in ACA exchange plans, because we're still in the middle of the open enrollment period; even then, the percentage of those enrollees who will be receiving APTC assistance is still unknown as well...and even then, not all of those folks will be receiving substantial subsidy assistance which would make or break their ability to keep their policy.

Every month I post an entry about the official CMS Medicaid enrollment report, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees. I wrote about the August 2016 report back on 11/20, and normally would be writing about the September report today. Instead, however, I'm skipping right past September, because the preliminary report for October was just released today:

As anyone who's visited the site the past few days knows, I've spent countless hours digging up data to find out exactly how many people are enrolled in Medicaid/CHIP specifically due to the ACA's expansion provision. This is much more difficult than you'd think for a variety of reasons. For one thing, each state seems to have different methodology for how they track and report Medicaid enrollees (some weekly, some monthly, some quarterly, etc). For another, there's a wide variety of eligibility thresholds under pre-ACA Medicaid for different groups of residents in each state (pregnant women, infants, children, parents, etc), and since the funding mechanism varies depending on whether the enrollee qualifies for "normal" Medicaid or "ACA expansion" Medicaid, categorization can be tricky. Finally, due to the churn factor (people moving up and down the income scale as well as gaining or losing job-based or other forms of coverage), the numbers can jump around from month to month or even week to week.

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