As I noted a couple of weeks ago, I've relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.
...over the past few years, the voters of some of those states have decided to take it upon themselves to force their legislators/governors to expand Medicaid anyway, via statewide ballot initiative campaigns:
I've noted before that enrollment in Michigan's ACA Medicaid expansion program, "Healthy Michigan", has risen sharply over the past year since the COVID-19 pandemic hit; it's up by over 1/3 since last February.
However, it's also worth noting that non-ACA Medicaid enrollment has also jumped significantly since the pandemic arrived. I've dug into data from the Centers for Medicare & Medicaid, the Kaiser Family Foundation and Michigan's Health Dept. archives and put together the graph below, showing that non-ACA Medicaid enrollment has risen from around 1.66 million Michiganders in February 2020 to over 1.92 million today, a 16% increase.
Combined, total Medicaid enrollment is up by around 21% to over 2.82 million as of April 2021.
Around half the 50 states (+DC) expanded Medicaid under the Affordable Care Act starting in 2014. Since then, roughly half of the remaining states have also done so, either via executive order by the Governor, a new state legislature coming around or, most frequently, via statewide ballot initiative.
I last updated my Michigan Medicaid expansion tracking back in January.At the time, I noted that enrollment in this ACA programhas increased dramatically here in Michigan since the COVID-19 pandemic struck, increasing from 673,000 in February 2020 to 853,000 as of January 2021, or nearly 27% in less than one year.
As of April 5th, the Healthy Michigan program (that's the branding of Michigan's ACA Medicaid expansion) notes 897,261 enrollees. That's a net increase of 224,000 Michiganders enrolled in the program since last February, or over 33%.
With this as backdrop, consider the timing of the following events:
The ACA's language didn't account for the possibility that some states might not expand Medicaid, which is why the lower-end range of exchange plan subsidy eligibility starts off at 100% FPL...
Unfortunately, those earning less than 100% FPL are still stuck without any viable options besides either "going bare" and praying they don't get sick or injured or possibly buying a junk plan of some sort. According to the Kaiser Family Foundation, there's around 2.2 million Americans still caught in the "Medicaid Gap", where they don't qualify for Medicaid but don't earn enough to be eligible for subsidized ACA exchange policies (Kaiser estimates another 1.8 million uninsured adults in these states in the 100 - 138% "overlap" cateogory, plus around 356,000 who are eligible for Medicaid but still haven't enrolled for one reason or another).
Republican lawmakers blocked Medicaid expansion funding from reaching the Missouri House floor on Wednesday, posing a setback for the voter-approved plan to increase eligibility for the state health care program.
The House Budget Committee voted along party lines not to pass a bill allowing Missouri to spend $130 million of state funds and $1.6 billion in federal money to pay for the program’s expansion. Under the Affordable Care Act, the federal government picks up 90% of the tab on expanding Medicaid.
The expanded eligibility would allow estimated 230,000 additional low-income Missourians to be covered. It is set to go into effect in July after voters approved a ballot question last August with a 53% majority.
Missouri just voted #YesOn2 to expand Medicaid, and now, because of YOUR vote, over 230,000 hardworking people will have access to life-saving healthcare!pic.twitter.com/azHN0GJjEW
— YesOn2: Healthcare for Missouri (@YesOn2MO) August 5, 2020
Last summer, when activists in both Missouri and Oklahoma were preparing for this historic vote, I wrote the following:
Last week the Maryland Health Benefit Exchange issued a press release touting impressive enrollment numbers over the past year via their year-long COVID-19 Special Enrollment Period (SEP). The topline number was that they enrolled over 140,000 Maryland residents in either ACA exchange policies or Medicaid.
Since Medicaid enrollment is open year-round anyway, the number I'm obviously more interested in are the exchange plans, which most people can normally only enroll in during the official Open Enrollment Period each fall/winter. Since COVID has thrown that mostly into disarray, however, I've been keeping a close eye on SEP enrollment in 2020 and now in spring of 2021 as compared to the pre-COVID era, when the SEP rules were far more strictly adhered to.
The American Rescue Plan does plenty to make private ACA-compliant health insurance dramatically more affordable for everyone earning more than 100% of the Federal Poverty Level. For those below 100% FPL, however, it takes an indirect approach. As I wrote a few weeks ago:
One possible "solution" would have been to simply remove the lower-bound income cut-off point for ACA exchange subsidy eligibility (that is, to lower the threshold from 100% FPL to 0%)...However, this would create two new problems: First, Medicaid is far more comprehensive than nearly all ACA plans...Secondly, if the lower-end subsidy cut-off were removed, it's almost certain that quite a few states which have already expanded the program would reverse themselves and allow Medicaid expansion to expire, in order to save the 10% portion of the cost that they have to pay.
