Monday, July 12, 2021

Democrat to voters: "Friend, this past year, we saw just how important Medicaid expansion was to hard-working..."

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Terry McAuliffe, once and would-be future governor of Virginia, is running on the ACA Medicaid expansion (which opponent Glenn Youngkin opposed) and building on the ACA.  Here's the lead in a weekend email to supporters: 

Friend, this past year, we saw just how important Medicaid expansion was to hard-working Virginians and to folks across the country. Before COVID-19 hit, 394,000 Virginians were enrolled in Medicaid. Now? It’s over 550,000.

That’s over 150,000 Virginians who had coverage during the worst global public health crisis in recent history because of Medicaid expansion. But our work is not over.

700,000 Virginians - including 100,000 children - don't have access to health insurance. We NEED to continue to expand coverage to make sure every single Virginian has great health care.

The language there is a little sloppy -- over 550,000 Virginians (562,530 if you're keeping score at home, up 43% since March 1, 2020)  were rendered eligible for Medicaid by the ACA expansion criteria.  In total, 1.86 million people in the state are enrolled in Medicaid, up from 1.54 million on March 1, 2020, an increase of 20%.  

That safety net performance at a time of mass (if partially temporary) unemployment and mortal danger to health is something for Democrats to be proud of, especially since they scripted the moratorium on Medicaid disenrollments (in the Families First Act of March 2020) that's largely enabled the increase. They should all run on it. Remember, Republicans came within a breath of repealing the ACA's core programs, chief among them the Medicaid expansion.

Virginia's Medicaid tallies during the pandemic are only modestly above the national average. My 34-state sample, updated below, show a 17.5%  increase from February 2020 to April 2021. 

Medicaid enrollment in 34 states, February 2020 -- April/May 2021 (click to enlarge)

As always: expansion states are in blue; nonexpansion states in red; quasi-expansion state Wisconsin in purple; and estimates in green.

Applying a rule of thumb that's held pretty steady (e.g., through January*), the cumulative growth rate recorded in my sample, which is based on available monthly reports issued by the states, generally exceeds CMS's official tally (which lags this tally by 3-4 months) by about half a percentage point (state reports differ from CMS's official count in numerous ways). That suggests total enrollment through April of about 83.3 million. At present, total enrollment is probably pushing 85 million -- an increase of 13-14 million since the pandemic struck.  For more context and explanation of my compilation practices, see this post and this post. [Update, 7/14/21: Given the just-released preliminary Feb. total of 81.0 million, this estimate seems high. The final tally for February will probably  be about 81.6 million; April may come in at about 82.9 million.  Further update, 8/16/21: Final February total is 81.4 million; CMS's total increase from Feb. 2020 through March 2021 is 15.6%. So my 34-state estimate is indeed coming in a full percentage point ahead of final CMS tallies for all states.]

The continuous increase in Medicaid enrollment since the pandemic landed has slowed somewhat this spring but will not end until the public health emergency that prompted the moratorium on disenrollments ends. Then, watch out below. The Trump administration, which in years prior to the pandemic had encouraged and pressured states to perform frequent income checks and disenroll those whose incomes crept over the eligibility threshold, issued guidance last December instructing states to begin preparing for the end of the emergency and to resume timely disenrollments within six months of the end of the emergency.  Inside Health Policy reports that progressive health policy analysts expect  the Biden administration to soften the guidance (and are presumably lobbying for such changes). The administration may encourage states to prepare for the end of the emergency by processing as many renewals as possible in advance of it; adopting year-long eligibility for new enrollees; and streamlining the renewal process and improve communication with enrollees.  Jennifer Wagner of the Center for Budget and Policy Priorities offered detailed recommendations last December.

When income checks do resume, many enrollees whose income has risen modestly above the Medicaid eligibility threshold will be eligible, thanks to the marketplace subsidy increases enacted in the American Rescue Plan, for free or near-free silver plan coverage with strong Cost Sharing Reduction in the marketplace. Medicaid agencies and the ACA exchanges ( and 15 state-based exchanges) need to work to smooth this transition.


* CMS's enrollment snapshot for January 2021 shows a 13.9% increase since February 2020, compared to 14.5% in my tally (shown above). Because the CMS total for January is preliminary (to be updated in the next report), it's set against the preliminary total for Feb. 2020 for comparison (70.7 million), whereas CMS's final total for that month is 71.2 million.  My projection for April 2021 is a 17% increase since Feb. 2020, based on the higher final total for Feb. 2020 (final totals for each month have exceeded preliminary totals by several hundred thousand in most months during the pandemic). UPDATE, 7/14/21: CMS has released its preliminary tally for February 2021 (81.0 million) and its final tally for January 2021 (80.9 million, up from a preliminary total of 80.5 million). 

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