• Uninsurance rates for the poor, by Medicaid expansion opt-in/out status

    The Advisory Board is tracking which states claim to be opting in or out of the Medicaid expansion, or leaning one way or the other. Here’s their map:

    Using the same color coding, here’s my chart, based on statehealthfacts.org data, of the uninsurance rate by state for the Medicaid expansion target population, adults with incomes below 139% FPL.* Click to enlarge.

    Notice that dark and light red states (those saying they’ll opt out or leaning that way) tend to cluster at the high end of the distribution. All but three of them have uninsurance rates above the national average. Dark and light blue states (those opting in or leaning that way) tend to have uninsurance rates below the national average, though three do not.

    Translation: States with populations that would benefit more from the expansion are disproportionately against adopting it. It also may be true that in those states the price of expansion is higher (more people, higher price, though you can’t infer the price from the proportion of uninsured). However, most of that price tag will be covered by the federal government and, on balance, many states will actually see a net savings due to reform.

    * You’ll see it written as below 134% FPL (or up to 133% FPL), but there is a 5% income disregard that makes it effectively below 139% FPL.

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    • One other thing is that many of those states currently have huge populations of people eligible for Medicaid but not enrolled. The price tag for expansion goes up a bit when you factor that in as the FMAP is considerably lower.

    • Austin,
      Good post, thanks for the info. Your last paragraph make some generalizations that deserve further scrutiny, however. In fact, if you click through to the hyperlink attached to “net savings,” and then go further to the study from the Urban Institute, the states that are opting out are the ones estimated to have the highest costs. Florida, Texas, and Missouri are the top 3, with Louisiana at #10. The only outlier appears to be Wisconsin.

      In other words, the study you linked that argues that “many states will actually see a net savings due to reform” ALSO shows that the “price of expansion is higher” in the opt-out states.

    • If the state legislatures in these huge states full of uninsured people refuse Medicaid expansion and keep their positions in their State House and Senates, it will be a true testament to the success of voter suppression efforts. Or perhaps there would be no voter suppression and that I am displaying a bias towards thinking health care is part of the common good and that these uninsured voters might vote to keep these very Medicaid non-expanders in office. Who am I to say?