Medicaid is primarily health insurance for poor people or very sick people.
Idaho’s legislature is monkeying around with the voter approved straight-up Medicaid expansion to 138% of the Federal Poverty Level (FPL).
Medicaid expansion news: Idaho House is debating today a bill which rolls back the voter approved Medicaid expansion and replaces it with a much weaker partial expansion and a work requirement. https://t.co/aqOHWouxjZ
— Joan Alker (@JoanAlker1) March 21, 2019
This will harm middle class Idaho families who need community rated, guaranteed issue insurance from the individual market.
How does that work if Medicaid is health insurance for poor people?
Cost Sharing Reduction (CSR) work-arounds of Silverloading and differential morbidity matter.
Adrianna MacIntyre and I argued in a Health Affairs blog that full expansion has two paths to decreasing premiums for people earning over 400% FPL that are not available if a state elects and receives a waiver for a partial expansion to only 100% FPL.
evidence found that Medicaid expansion improved the risk pool of state individual markets, suggesting that the population between 100 and 138 percent FPL is sicker and more expensive, on average, than other exchange enrollees. Insuring this cohort through Medicaid is associated with a seven to eleven percentage point decrease in individual market premiums. …
household incomes between 100 percent and 150 percent FPL, those that would be eligible for 94 percent AV silver plans. This income bracket overlaps the Medicaid expansion income group significantly. States that fully expand Medicaid end up with far fewer people in the most generous CSR bucket, as they have moved the 100-138 percent population to Medicaid
Keeping a cohort that is more expensive than the rest of the ACA individual market risk pool in the risk pool raises premiums. Pulling the 100-138% population out of the ACA risk pool lowers market premiums as long as this group is more expensive than average. Furthermore while Idaho has engaged in the Silver Switcheroo, Silverloading increases premiums for folks who want a Silver plan and buy it on Exchange either because they don’t know if they will be just over or just under the subsidy cut-off point of 400% FPL or they can’t access an off-Exchange plan that meets their requirements.
Full Medicaid expansion reduces the premium pain of the middle class. Partial expansion continues the pricing pain for the middle class.