Overall Growth in Medicaid Insured with Recent Declines
by Scott Richter and Dr. Patrick Jones
Dean Kamen, inventor of the Segway, said, “Nothing of value, real value, has no cost. Not freedom, not food, not shelter, not healthcare.”
While we share the cost of freedom, we also share the cost of food, shelter, and healthcare for those in need or who can’t afford through a variety of assistance programs – some public and some private.
The Patient Protection and Affordable Care Act, or more commonly known as the Affordable Care Act (ACA), became law in 2010. Some aspects of the law quickly went into effect, such as extending dependent coverage to the age of 26 and eliminating lifetime limits imposed by insurers.
Most notably, the ACA expanded eligibility of Medicaid “to adults with incomes up to 138 percent of the federal poverty level (FPL).”
The first Open Enrollment for the new health insurance marketplace occurred on October 1, 2013 with all health plans purchased before December 23, 2013 going into effect on January 1, 2014.
As an individual state, Washington adopted Medicaid expansion under the ACA with full implementation occurring on January 1, 2014.
According to the Kaiser Family Foundation, during 2016 in Washington State, about 62% of adult Medicaid enrollees were working, and Medicaid covered approximately: 40% of all children, 60% of all nursing home residents, 17% of all adults, and half of all persons with a disability.
According to the National Conference of State Legislatures, by early November, 2018, only 14 states had not opted in to ACA-related Medicaid expansion. The remaining 36 states had either expanded, had expansion approved through a voter ballot initiative but not yet implemented, or were currently in the process of expanding using a Centers for Medicare & Medicaid Services (CMS) Section 1115 Waiver. The Section 1115 Waiver allows “states to test new or existing ways to deliver and pay for health care services in Medicaid and the Children’s Health Insurance Program (CHIP).”
While the purpose of this article is to dig into the Total and Share of the Population Insured by Medicaid indicator on the Trends website, we remain neutral and let the data speak for itself, including the ACA. However, this indicator is highly affected by changes in health care laws authorized by the ACA.
The latter part of this graph (2013-2017) shows both a greater number and share of Spokane County residents insured by Medicaid than the first half of the series (2009-2013).
Three other indicators on the Trends website, the Overall Uninsured Population, Uninsured Population by Age Groups, and Uninsured Population by Poverty Status also reflect how Medicaid expansion in Washington State created more access for people to acquire health insurance.
One of the larger questions posed by this indicator is why the share of Medicaid insured in Spokane County decreased slightly in both 2016 and 2017 from the peak in 2015.
According to Alison Poulson, Executive Director, Better Health Together, there are a variety of possibilities, but it’s too soon to know for sure why these decreases have occurred.
Poulson said, “According to a report released by the Washington State Employment Security, the ACA created roughly 1,350 new health-related jobs in the state and reduced the amount of donated care from our health systems. The growth in the number of people insured by Medicaid created a simultaneous demand for more healthcare workers.”
Local community health providers, such as CHAS, were able to greatly expand their reach by building new facilities in many communities in eastern Washington. This was possible, in part, due to funding opportunities for federally qualified health centers who had always treated low income patients with or without insurance.
With both private and public health insurance markets affected by recent federal changes to portions of the ACA, this indicator will perhaps also reflect the volatility and churn in health insurance markets.