Maine’s voters look like they are about to authorize a Medicaid expansion.
— Portland PressHerald (@PressHerald) November 8, 2017
The Congressional Budget Office throughout 2017 analyzed Republican Repeal bills. They consistently estimated that several million people would have lost coverage by the end of the projection window because they lived in states that had not yet expanded Medicaid but would have expanded Medicaid at some point.
This makes sense. We knew that Maine was continually trying to pass Medicaid Expansion only to see it vetoed. We saw Virginia’s Democratic governor try to accept Expansion. We saw Kansas approve expansion and only see it vetoed. We are seeing Idaho doing back-flips to not expand Medicaid while expanding coverage for tens of thousands of people who make under 100% FPL (<$12,060 for a single individual). Oklahoma has a complex waiver plan to cover everyone under 100% FPL as well. There is a desire by states to have the federal government pay to cover the healthcare costs of more of their citizens. I could see quibbles about how many states that have not expanded will expand and how fast, but the core assumption makes sense to me. It did not make sense to the Apothecary’s Josh Archambault:
But a cursory look at the CBO’s own data raises serious questions about its headline conclusion and should make many in Congress ask CBO some tough questions.
CBO’s projected Medicaid losses have their own problems. For example, 5 million are projected to “lose” Medicaid expansion coverage in states that never expanded Medicaid in the first place….
AEI’s Joel Zinberg made a similar attack on the CBO assumption that Medicaid Expansion would continue:
The CBO predicts the AHCA will decrease Medicaid by 4 million by 2018, 9 million by 2020, and 14 million by 2026. It estimates 5 million of this loss will come from, “… people who CBO projects would, under current law, become eligible in the future as additional states adopted the ACA’s option to expand eligibility.” But there is little evidence that the 19 states which have thus far not expanded eligibility under the ACA would choose to do so in the future, particularly since under the ACA states will now have to start sharing some of financial burden for these newly eligible enrollees with the federal government.
Maine is a demonstration case that states will continue to expand. Kentucky is a demonstration case that Expansion so far is a one-way ratchet. A 9:1 match with the ability to shift some state costs to the Feds is an attractive offer. It is reasonable to assume that more states will take it up.