Now get your minds out of the gutter… I’m talking about Medicaid expansion market penetration.
Traditional/Legacy Medicaid had an adult penetration rate of around sixty five percent. Two out of three adults who were eligible for Medicaid signed up for it. This varied by state as some states aggressively pushed to sign people up, and others exhibited benign indifference at best to making sure their working poor adult population had decent health coverage. Kids tended to be in much shape as the combination of CHIP and the basic fact that telling a poor kid to shut up and die quietly is a good way to lose general elections even if it is a winner in a Republican primary.
Medicaid expansion for the states that have taken it is primarily aimed at non-disabled adults who are not destitute but are working poor.
And here is where I am impressed as I see the following pieces of analysis from Charles Gaba:
As an aside, according to KFF, there were around 259,000 uninsured Minnesota residents eligible for Medicaid (pre-ACA + expansion) prior to January 1st. Assuming none of the 205,896 people who enrolled via the MNSure exchange were renewals (and they shouldn’t be, according to the prior monthly CMS reports), that suggests that MN has now enrolled nearly 80% of all eligible residents who weren’t already on Medicaid, leaving just 52,000 people to go, give or take.
The Kaiser Family Foundation estimated that WV has 143,000 residents eligible for Medicaid expansion. This means the state has now enrolled nearly 89% of them:
Bowling said the most up-to-date data show about 128,000 people have joined Medicaid through the expansion, much more than the roughly 91,000 anticipated to sign up. She said that success means the state probably won’t send out another round of letters, but the numbers keep rising as those eligible may sign up at any time.
But there’s more! As I noted a couple of weeks ago, KFF.org estimated that the total number of uninsured Kentuckians who were eligible for Medicaid (expansion + Woodworkers) prior to January 1st was around 350,000. Kentucky has consistantly reported that roughly 75% of both QHP enrollees and new Medicaid enrollees via the KynectKY exchange were previously uninsured.
This strongly suggests that Kentucky has now enrolled at least 272,000 of those 350K…or 78% of the total.
I think there are a couple of things going on. First, the awareness of the mandate and the massive marketing campaign (both for and against enrollment in health insurance (and yes, it is lunacy that there has been and will be a multi-hundred million dollar marketing campaign aimed at getting people to not enroll in health insurance)) has made plenty of people aware of their options. Secondly, and more importantly in my mind, is the fact that the federal government is picking up 100% of the cost of Expansion for the first three years. This removes the institutional incentive structure of state and county workers from not signing up everyone as legacy Medicaid would have seen the state pick up 40% to 50% of the costs of coverage. Now this is effetively “free” coverage from the point of view of the bosses of the field workers who process applications and find people who can benefit from publci programs. I’ll be curious to see if the 10% state cost-share in 2017 reintroduces creative and quasi-deliberate incompetence in outreach efforts.