GOP States Still Face Big Health Care Costs As ACA Is Unwound
WASHINGTON - States that fought and shunned the Affordable Care Act's Medicaid expansion, hoping to avoid the cost of covering millions of working-poor families, will be left with substantial growth in the program even after the Republican-led Congress unwinds the law.
From Florida and Texas to Georgia and North Carolina, enrollment in Medicaid and the Children's Health Insurance Program has soared since the passage of the health care law, as the poor and uninsured have come out of the woodwork to apply for coverage. And those new enrollees - 2.4 million people across 19 states that decided not to expand Medicaid - aren't going anywhere immediately after the incoming Donald Trump administration signs repeal legislation into law.
It's an ironic and unintended parting gift from President Barack Obama, whose namesake health care package triggered a rush to Medicaid that will leave some of the most conservative states in America spending more than expected to insure the poor after he leaves office than they did before he entered.
"The states that did not expand essentially saved nothing, collectively lost out, literally, on hundreds of billions of dollars in federal financing, left millions of people with no coverage and at the same time have experienced enrollment growth because of the streamlining in the Affordable Care Act. So they they ended up harming only their own populations and not helping themselves economically at all," said Sara Rosenbaum, professor of health policy and management at George Washington University.
Experts call the growth in Medicaid enrollment in states that did not expand "the woodwork effect." It refers to people eligible for Medicaid before the Affordable Care Act - but not enrolled - who joined amid public awareness campaigns for HealthCare.gov and the Medicaid expansion.
Even when the Affordable Care Act is repealed, woodwork-effect enrollees in states that did not expand Medicaid are unlikely to lose their coverage.
That's because newly eligible Medicaid enrollees in expansion states can earn up to 138 percent of the federal poverty level, because of the health care law's relaxed income eligibility requirements. But woodwork enrollees in non-expansion states had to meet Medicaid's traditional state-income guidelines reserving coverage for very low-income applicants.
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