Amazing. Oklahoma's ballot initiative to participate in Medicaid expansion just passed. It will bring health insurance coverage to nearly 200,000 state residents. A bright spot in dark times. pic.twitter.com/nkDvGRYo9L
— Vivek Murthy (@vivek_murthy) July 1, 2020
Oklahoma voters (or at least the narrow subslice that vote in mid-summer, mid-pandemic primary elections) approved Medicaid expansion last night. This will lead to 200,000 more people being insured once the system is ready to start enrolling people. The referendum was for a straight up state plan amendment expansion with a fairly rapid turn-around. There is no work requirements or angels dancing on the heads of a pin administrative burden built into the law. The newly eligible population can not be treated any differently than categorically eligible populations which will provide the newly eligible populations significant protection from future shenanigans.
Now what does this mean?
First, it means 200,000 more people will be insured. It means plenty of people are going to see their stress levels decrease. It will mean rural hospitals will have a lifeline. It will mean a large fire hose of federal money will be going into the state.
I am intested in the ACA markets. We have strong reason to know that Medicaid expansion lowers ACA gross premiums. I wrote the following when Virginia was debating Medicaid expansion:
First, more individuals with chronic conditions will have access to regular care — a factor we know helps reduce expensive visits to emergency rooms and high-cost hospitalizations. Evidence shows that individuals who earn between 100 percent and 138 percent of the federal poverty level (a family of four earning between $25,100 and $34,638) and currently buy ACA insurance have more chronic conditions and more expensive health care needs than individuals who earn over 138 percent FPL…
The second mechanism that could lead to premium reductions for the middle class is a little harder to follow, but is a result of President Donald Trump’s October 2017 termination of payments for cost-sharing reduction subsidies to insurers….
Virginia — like many other states — had its insurers load the cost of providing CSR into the premiums for silver plans, which are the plans that set the local benchmark from which all premium subsidies are calculated. This led to a significant spike in silver benchmark premiums. Other plans saw significant but far lower premium increases. On average, CSR workarounds led to an extra $960 to $1,040 in premiums for silver plans.
Depending on how fast the actuaries for Oklahoma ACA insurers act and how quickly they assume MEdicaid expansion will roll out and enroll the entire eligible population, we could anticipate a significant decrease in gross premiums for 2021 and a slight increase in net premiums for subsidized individuals.
On net, Medicaid expansion massively helps more people than it hurts in regards to obtaining and maintaining insurance coverage.
Missouri will vote on Medicaid Expansion in the first week of August.