Charles Gaba has a good post on the Medicaid Trap due to the Supreme Court making Medicaid Expansion voluntary and an ad-hoc work-around that is in play. He lays out a reasonable scenario, but I saw something that to me is the equivilent of nails on a chalkboard as he started to draw policy conclusions together.
Besides, according to KFF.org, the Medicaid program costs $3,263 per adult in Texas ($6,526 for two adults), which means that it would actually cost the taxpayers less to enroll this couple in Medicaid anyway ($6,526/year vs. $6,852).
I really don’t like these types of simple straight up comparisons, especially in states where the Legacy Medicaid eligiblity restrictions were very tight. Texas has very tight limits where healthy adults that were no on Social Security Disability (SSI) with no kids had no chance of qualifying for Medicaid. People in nursing homes and people on SSI qualified for Texas Medicaid. The pool of people who are in the Medicaid Trap is most likely not directly comparable to the current pool of reasonably healthy adults who are not on SSI nor in nursing homes but are still on Texas Medicaid. My bet is the currently enrolled pool is younger, more female, and much poorer with far fewer assets (ie a working car etc) than people who would only qualify for Texas Medicaid expansion.
The expansion pool is probably older (more expensive), more male (slightly cheaper), and has a few assets/more stability (slightly cheaper).
A direct comparison on costs can’t be done unless there is a damn good idea of the actual or projected utilization profiles of the populations. Actuaries will do that as that is their job, but it can’t be done at a glance.