Deep penetration is oh so good

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.

Michigan (in only 3 months):

Michigan: ACA Medicaid expansion up to 318K (64% of total eligible)

West Virginia:

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, 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.

27 replies
  1. 1
    Baud says:

    Now get your minds out of the gutter


  2. 2
    JPL says:

    The NY Times has and article on urgent care centers today. I didn’t realize that most don’t accept medicaid patients. I understand that they are profit making organizations, but it seems that if you want to cut down on emergency room visits, urgent care is a better model to cut expenses. link

  3. 3
    another Holocene human says:

    Damn you, Richard. Or should I say, Dick?

    Hm, finished coffee. More coffee is called for!

  4. 4
    Cervantes says:

    It’s not sex that is in the gutter, it’s that Republican primary you mention.

  5. 5
    Skippy-san says:

    The gutter is a step up.

  6. 6
    Skippy-san says:

    The gutter is a step up.

  7. 7
    Shakezula says:

    Ah-ha! So you admit DemocRATs are ramming Obamacare way down our throats! [Rides off in Medicare-covered Hoveround.]

  8. 8
    Violet says:

    I’ll be curious to see if the 10% state cost-share in 2017 reintroduces creative and quasi-deliberate incompetence in outreach efforts.

    It will. Are the penalties for not having health insurance going up as well so there will be more incentives to get it? Guess that may not apply to Medicaid folks.

    Are there any penalties to states for having low numbers off people covered with health insurance? If that was built in then they’d be more likely to want to have their folks covered.

  9. 9
    Richard Mayhew says:

    @Violet: The mandate has a hardship exemption and folks who are Medicaid eligible in expansion states might quality for it. For non-expansion sadist states, people in the coverage gap won’t be hit by the mandate penalty under current rules.

  10. 10
    Violet says:

    @Richard Mayhew: Question: If a 19 year old still lives with his parents but has no income (or very little), is he eligible for Medicaid if the parents have no health insurance? He isn’t in college and as far as I know has no plans for it–although maybe he’ll take some community college classes or something in the fall.

    Red state that refused the Medicaid expansion so I guess that isn’t an option. Would there be other low-income options for 19 year olds? He keeps doing dumb stuff with his bike and skateboard and other things and getting minor injuries. I keep thinking he has to be in a cheap demographic for insurance coverage that would cover him if he really got hurt.

  11. 11
    Patricia Kayden says:

    This is really great news for the ACA (and President Obama). Needs to be tweeted near and far.

    Good luck to those who are trying to repeal the ACA.

  12. 12
    Richard Mayhew says:

    @Violet: not sure, speak with a navigator (they are still around). You can probably get family coverage as he is under 26.

  13. 13
    Violet says:

    @Richard Mayhew: Thanks.

  14. 14

    California’s expansion isn’t going quite so smoothly. The state currently is sitting on just shy of a million medicaid applications struggling to get them processed. They’re coming in faster than they can be approved and about 2 million total have applied since last October, so they’ve approved about half of them.

    The good news is that information has flowed successfully and people are doing what they need to. The bad news is that the people that have applied aren’t able to use the coverage and it’s unclear how long it will take for applicants to get care. But it seems to me that they’ll be lucky to clear the backlog before the next open enrollment period hits.

    But that’s potentially another million people getting coverage once the paperwork is approved. It’s also unclear what the makeup of that pool is. Undocumented immigrants are eligible for Medical, and I don’t know if these numbers include them or not. I would suspect they do, but they probably wouldn’t count in the federal counts either because they’re undocumented or because federal dollars aren’t paying for the coverage.

    Related, TPM links to an article dissecting he-who-would-penetrate-McMegan and his anti-Obamacare analysis that is collapsing under its own incompetence.

  15. 15
    Shakezula says:

    @⚽️ Martin: I think that by 2020 people like Blunderman will be reduced to arguing that Obamacare shouldn’t have worked, therefore there must have been some sort of shenanigans, therefore mumble garrble repeal is the only answer. And teaching people to rely on the government, also.

  16. 16
    Pyro Joe says:


    Not Richard obviously, but is he in an expansion or non-expansion state ? Does he fall into the gap?

  17. 17
    Pyro Joe says:

    And just disregard that last comment Violet. Didn’t see that you already mentioned it, sorry

  18. 18
    Villago Delenda Est says:

    @Skippy-san: /shakefist

    You stole the line I was going to use!

    (And Mayhew knows his readership all too well, it seems. Which is PRECISELY why he chose that title for his post)

  19. 19
    rikyrah says:

    once again, I love your posts…thank you

  20. 20
    Cervantes says:

    Richard, have you seen Niam Yaraghi’s recent article at Brookings?

    In fact, after controlling for other state characteristics such as low per capita income population and average insurance premiums, I observe a positive association between the anti-ACA spending and ACA enrollment. This implies that anti-ACA ads may unintentionally increase the public awareness about the existence of a governmentally subsidized service and its benefits for the uninsured.

    On the other hand, an individual’s prediction about the chances of repealing the ACA may be associated with the volume of advertisements against it. In the states where more anti-ACA ads are aired, residents were on average more likely to believe that Congress will repeal the ACA in the near future. People who believe that subsidized health insurance may soon disappear could have a greater willingness to take advantage of this one time opportunity.

    Funny, at least.

  21. 21

    @Shakezula: Why do people even read Mr. McArgleBargle? His position is never a surprise.

  22. 22
    Richard Mayhew says:

    @Cervantes: yeah, I’ve been playing with a couple of post ideas about this in my head — nothing too good has marinated yet.

  23. 23
    karen says:

    I’m in liberal MD. I now qualify for Medicaid when I wouldn’t have otherwise. Thanks to that Medicaid, my upcoming double mastectomy, my BRCA1 & 2, my hospital room and all the doctor’s visits and tests I’ve had so far have not cost me a dime. The meds are $3 for brand names and $1 for generics. I would be highly upset if the GOP removed Medicaid.

  24. 24
    mclaren says:

    Once again, Richard Mayhew is lying to you. This time he’s lying by implication. The strong implication of his dishonest post is that the ACA is promoting all sorts of wonderfulness, so signups will mean reduced costs.

    This is a lie because doctors have adjusted their behavior to the ACA and are now billing more than ever:

    Kim Little had not thought much about the tiny white spot on the side of her cheek until a physician’s assistant at her dermatologist’s office warned that it might be cancerous. He took a biopsy, returning 15 minutes later to confirm the diagnosis and schedule her for an outpatient procedure at the Arkansas Skin Cancer Center in Little Rock, 30 miles away.

    That was the prelude to a daylong medical odyssey several weeks later, through different private offices on the manicured campus at the Baptist Health Medical Center that involved a dermatologist, an anesthesiologist and an ophthalmologist who practices plastic surgery. It generated bills of more than $25,000.

    “I felt like I was a hostage,” said Ms. Little, a professor of history at the University of Central Arkansas, who had been told beforehand that she would need just a couple of stitches. “I didn’t have any clue how much they were going to bill. I had no idea it would be so much.”

    Ms. Little’s seemingly minor medical problem — she had the least dangerous form of skin cancer — racked up big bills because it involved three doctors from specialties that are among the highest compensated in medicine, and it was done on the grounds of a hospital. Many specialists have become particularly adept at the business of medicine by becoming more entrepreneurial, protecting their turf through aggressive lobbying by their medical societies, and most of all, increasing revenues by offering new procedures — or doing more of lucrative ones.

    It does not matter if the procedure is big or small, learned in a decade of training or a weeklong course. In fact, minor procedures typically offer the best return on investment: A cardiac surgeon can perform only a couple of bypass operations a day, but other specialists can perform a dozen procedures in that time span.

    That math explains why the incomes of dermatologists, gastroenterologists and oncologists rose 50 percent or more between 1995 and 2012, even when adjusted for inflation, while those for primary care physicians rose only 10 percent and lag far behind, since insurers pay far less for traditional doctoring tasks like listening for a heart murmur or prescribing the right antibiotic.

    By 2012, dermatologists — whose incomes were more or less on par with internists in 1985 — had become the fourth-highest earners in American medicine in some surveys, bringing in an average of $471,555, according to the Medical Group Management Association, which tracks doctors’ income, though their workload is one of the lightest.

    In addition, salary figures often understate physician earning power since they often do not include revenue from business activities: fees for blood or pathology tests at a lab that the doctor owns or “facility” charges at an ambulatory surgery center where the physician is an investor, for example.

    “The high earning in many fields relates mostly to how well they’ve managed to monetize treatment — if you freeze off 18 lesions and bill separately for surgery for each, it can be very lucrative,” said Dr. Steven Schroeder, a professor at the University of California and the chairman of the National Commission on Physician Payment Reform, an initiative funded in part by the Robert Wood Johnson Foundation.

    Doctors’ charges — and the incentives they reflect — are a major factor in the nation’s $2.7 trillion medical bill. Payments to doctors in the United States, who make far more than their counterparts in other developed countries, account for 20 percent of American health care expenses, second only to hospital costs.

    Source: “Patients’ Costs Skyrocket; Specialists’ Incomes Soar,” The New York TImes, 18 January 2014.

    Notice how Mayhew couches his lies — he tells all the “good” news about ACA enrollments way, way up…but he neglects to tell you about the bad news that medical costs have skyrocketed far more. In fact, in Massachusetts, the ground zero for Obama’s Republican-lite non-reform health care “reform,” medical costs are up sharply by far more than in neighboring states since they put this non-reform “reform” in place.

    Which makes perfect sense. Doctors, hospitals, imaging clinics and insurers aren’t stupid. Tehy simply adjust their behavior in order to keep those medical costs skyrocketing, along with their income.

    Richard Mayhew lies and lies and lies and lies and lies and lies and lies. Essentially everything he has posted boils down to some kind of deliberate deception. The reality? Doctors now routinely bill insurance companies for patients they have not even seen or examined.

    The only way to fix America’s crisis of skyrocketing health care costs is to take the profit out of the equation. Nationalized single-payer health care is the only solution. Anyone who tells you otherwise, like Richard Mayhew, is lying to you in order to scam you.

    Email John Cole. Beg him to throw Richard Mayhew off this forum. This is the reality-based community, not a place for spin and lies and scams that obscure the facts.

  25. 25
    bemused senior says:

    @mclaren: You are an idiot. See this prior post.

  26. 26
    Richard Mayhew says:

    @bemused senior: But that has been previously established. And why would McLaren actually look at national GDP composition numbers when he can use anectdotes.

  27. 27
    Richard Mayhew says:

    @mclaren: Ok, find 218 votes in the House, and 51 in the Senate or at least a plausible pathway to those numbers that don’t involve a president bullypulpiting and green lanterning a threat to nationalize the US healthcare delivery system as that was your plan last time.

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