July 6, 2012—More than 1.3 million uninsured adults in Texas and nearly a million in Florida would get no additional help obtaining health coverage under the Affordable Ace Act (ACA) if their states decide not to expand their Medicaid programs as provided for under health care reform, according to new estimates from the Urban Institute Health Policy Center.
According to the think tank, 22.3 million uninsured individuals with incomes below 138 percent of the federal poverty level would be eligible for Medicaid if all states fully implement ACA’s expansion of Medicaid.[ms-protect-content id=”2799″] The recent U.S. Supreme Court decision upholding ACA left it up to states to decide whether to go along with the expansion. Some have said they definitely will not expand their programs or are leaning against doing so, including Texas, Florida, Louisiana, and Wisconsin.
These states’ governors have raised concerns about expanding the program when it is already consuming a large share of their states’ budgets. Under ACA, the federal government will pick up 100 percent of the cost of Medicaid’s expansion during 2014 through 2016 only, with the percentage gradually dropping to 90 percent for 2020 and beyond.
Of the 22.3 million uninsured individuals identified by the Urban Institute, 4.4 million are adults who are currently eligible for Medicaid but not enrolled and another 2.9 million are children who are eligible either for Medicaid or the Children’s Health Insurance Program but not enrolled. That leaves 15.1 million who are adults who are currently not eligible for Medicaid but would become so under its expansion.
Of those 15.1 million, 3.6 million might quality for health insurance exchange subsidies, the study found. The other 11.5 million “would not receive any additional help obtaining health insurance coverage under the ACA if their state does not expand its Medicaid program,” the study stated.
In addition to the 1.3 million in Texas and 995,000 in Florida who would get no extra help, 260,000 in Louisiana and 145,000 in Wisconsin would be left without a means of obtaining coverage, the study found. Florida is on record as unwilling to expand its Medicaid program, and the other three states are said to be leaning against doing so.
Hospitals groups are concerned about the prospect of large numbers of states deciding not to expand their Medicaid programs. As the National Association of Public Hospitals and Health Systems explained in a recent communication with its members, “to the extent that states do not implement the expansion, more uninsured individuals will remain than Congress anticipated when it passed the ACA.” Health care reform’s reductions of Medicaid and Medicare disproportionate share (DSH) hospital payments, it continued, “were premised on the idea that fewer uninsured would mean less uncompensated care to be supported through DSH.”[/ms-protect-content]