Friday, November 13, 2020

ACA Medicaid expansion enrollment continues to swell as pandemic surges

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 As our woes show no sign of abating -- 120,000-plus new Covid-19 cases per day, a million new jobless claims per week -- neither does Medicaid expansion enrollment. This part of the ACA is providing a vital safety net. The sampling below (states that have reported expansion category enrollment through October) indicates that enrollment growth did not slow in October.

How representative is the sample? Well, August growth is about 1 percentage point higher in this sample than in the larger (18-state) sample I posted for that month. California, where Medicaid enrollment has been almost flat in pandemic months, drags down the all-state rate of increase by probably another 2 percentage points. I am pretty confident that expansion-category enrollment growth since February tops 20% nationally. For more about my various assumptions, see this post (and this September update).

Pandemic Medicaid expansion enrollment in 12 states
February thru October 2020

 Idaho increase through August is estimated at a rate comparable to Sept-Oct increase.

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As of mid 2019, Medicaid "Group VIII" enrollment  -- enrollees rendered eligible by ACA criteria (adults with income up to 138% FPL), for whom the federal government foots 90% of the bill -- stood at 15.3 million.  It probably now tops 18 million. 

Total Medicaid enrollment is probably up by well more than 7 million since February. It should be kept in mind that much of the net enrollment growth during the pandemic months stems from the suspension of regular disenrollments for the duration of the national emergency mandated by the Families First Act, enacted March 18.

This week the Urban Institute published survey results indicating that among the one in seven U.S.  adults who reported that they or a spouse lost a job since March, the percentage enrolled in Medicaid increased from 12.8% to 16.8%. Surprisingly (to me), Urban found that the percentage of this group enrolled in individual market health plans increased even more sharply, from 8.5% to 11.7%. Charles Gaba is currently digesting information from state-based ACA exchanges indicating that normal month-by-month attrition in marketplace enrollment has been cut in half this year; I'll add the link when he posts on this. Previously, I've noted California's impressive net increase in marketplace enrollment from first to second quarter this year, along with other indications that reduced attrition might translate to a net enrollment increase of over a million relative to last year.

The ACA provides a patchy safety net for those who lose job-based coverage, but together with COBRA it appears to be doing its job. Incredibly, the uninsured rate does not appear to have risen during the pandemic months, though it may worsen as more layoffs become permanent. A flat uninsured rate is indicated not only by the Urban survey but by the weekly, experimental "pulse" survey carried out by the Census Bureau. The pulse results are volatile, but over an extended period do not show an increase in the uninsured.

Related
Medicaid expansion enrollment has increased by more than 2 million
ACA marketplace enrollment in Covid-19 season
How many newly uninsured? Families USA and the feds paint different pictures

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1 comment:

  1. Will the individual states have to come up with more money for their Medicaid match, or are the recent increases funded by the feds? I have lost track of how this works.

    If the states are responsible, this could be a big problem by winter.

    ReplyDelete