October 18, 2013—A flurry of new reports by leading health care think tanks shed more light on the fact that uncompensated care will remain a major challenge even after the Affordable Care Act (ACA) is implemented, especially in the 26 states that are not expanding Medicaid under the law.[ms-protect-content id=”2799″]
One of the studies, a joint project by the Urban Institute and Robert Wood Johnson Foundation, found that in the states not expanding Medicaid, only 38 percent of those who are presently uninsured would qualify for subsidized private insurance through the new insurance exchanges or other health coverage assistance programs. Even in the 25 states that are expanding Medicaid (including the District of Columbia), 33 percent of the currently uninsured would still be ineligible for insurance subsidies, Medicaid, or CHIP.
The study’s state-by-state projections of the numbers of individuals who would remain uninsured under ACA add up to 30.7 million nationwide. That roughly jibes with the Congressional Budget Office’s (CBO) projection last May of 31 million.
A second study, by the Kaiser Family Foundation, zeroes in on adults in states that are not expanding Medicaid who will qualify for neither Medicaid nor insurance subsidies—a phenomenon Kaiser calls the ACA’s “coverage gap.” These are people who earn too much to be eligible for Medicaid but earn too little to qualify for ACA’s health insurance tax credits. The study projects that 5.2 million adults will fall into this category, ranging from more than 1 million in Texas, to 242,000 in Louisiana, and 17,000 in both Alaska and Wyoming.
A third study, also by Kaiser, projects an 11.8 percent increase in Medicaid enrollment and a 13 percent increase in Medicaid spending in fiscal year 2014 for states moving forward with expansion. In states that are not expanding their programs, enrollment is expected to grow by 5.3 and spending by 6.8 percent.
Finally, in a related development, the subscription-based Bloomberg Government news, data, and analysis service issued a report on the 340B program this week that, among other things, examines how Medicaid expansion might raise the number of hospitals eligible for 340B drug discounts. Bloomberg notes, however, that “safety net hospitals in non-Medicaid expanding states will be challenged as they brace for billions of dollars in ACA-mandated reimbursement cuts without realizing the offsetting benefits—including easier 340B eligibility—associated with expansion.”
“These studies underscore that even with more Americans becoming insured under the ACA, there clearly will still be a need for the 340B program,” said Safety Net Hospitals for Pharmaceutical Access, which represents hospitals enrolled in the drug discount program. “There will continue to be substantial numbers of uninsured and underinsured individuals as well as inadequate health care reimbursement rates. 340B providers will play a key role in treating newly-insured Medicaid patients and will continue to rely on 340B savings to offset losses incurred by treating America’s most vulnerable patients.”[/ms-protect-content]