Is Medicaid expansion reducing SSI claims? If so, an uninsured diabetic in Tennessee called it

There is some evidence that the ACA's Medicaid expansion may be reducing claims for Supplemental Security Income (SSI). While such claims are dropping across the US as employment picks up, they're dropping somewhat faster in states that opted in to the ACA Medicaid expansion Modern Healthcare's Virgil Dickson reports:

The number of Americans applying for Supplemental Security Income benefits dropped in the first six months of this year compared to the same period last year, and experts are debating whether the decline is partly related to the healthcare reform law's Medicaid expansion to low-income adults.

A total of 1,189,567 SSI disability claims—mostly related to physical or mental disability— were filed in the first six months of 2014, compared with 1,330,169 during the same period last year, a drop of 10.6%, according to data obtained by Modern Healthcare from the Social Security Administration through a Freedom of Information Act request. The total decline in SSI claims in states that expanded Medicaid in the first six months of 2014 was 11.2%, compared with 10.0% in non-expansion states.

Back in June 2012, an uninsured diabetic waiting in line for treatment at a Remote Area Medical clinic in rural Tennessee forecast such a drop to New Republic reporter Alec MacGillis:

Will the ACA reduce the disability rolls?

Two years ago, I was riveted by TNR reporter Alec MacGillis' chat with a woman on line for a free REM medical clinic in rural Tennessee. Notwithstanding that she knew nothing about the ACA, she offered a stunning instant analysis, once the basics were described to her, of one likely economic effect:

..it it was hard to find visitors to the clinic who would not benefit directly from the law. Barbara Hickey, 54, is a diabetic who lost her insurance five years ago when her husband was injured at his job making fiberglass pipes. She gets discounted diabetic medication from a charity, but came to the clinic to ask a doctor about blood in her urine.

Under the law, she would qualify for Medicaid. Her eyebrows shot up as the law was described to her. "If they put that law into effect, a lot of people won't need disability," she said. "A lot of people go onto disability because they can't afford health insurance."

Lo, Ms. Hickey was a prophet (perhaps). In Arkansas, which has sliced its uninsured rate almost in half since ACA enactment, mainly by enrolling nearly 200,000 Arkansans in the state's "private option" Medicaid alternative, disability claims seem to be dropping.* Modern Healthcare's Paul Demko reports:**

When SSI is the only route to health insurance

Re that Nicholas Kristof column alleging skewed incentives in the children's Supplemental Security Income (SSI) program: in a prior post, I looked at a study Kristof cited that does not clearly demonstrate what Kristof implies it does --that an undue proportion of children on SSI transition directly to adult SSI when their eligibility for the children's benefit ends at age 18.

The 2009 study, by Jeffrey Hemmeter, Jacqueline Kauff, and David Wittenberg, does indicate a variety of incentives, some of them potentially perverse, for staying on children's SSI while eligible and for transitioning to adult SSI if possible.  One set of incentives is indeed skewed, thanks to a dearth of resources outside the program.  It's this: SSI, for children and adults alike, can be the only source for health insurance and specific health services:

Would the ACA reduce the number of Americans on disability insurance?

What do people who have lined up all night (in their cars) for a day of free medical care at a Remote Area Medical clinic in rural Tennessee think of the Affordable Care Act?

Many have never heard of it, reports TNR's Alec MacGillis in Kaiser Health News. But one uninsured patient offered instant economic analysis that the CBO would be well advised to take note of:

..it it was hard to find visitors to the clinic who would not benefit directly from the law. Barbara Hickey, 54, is a diabetic who lost her insurance five years ago when her husband was injured at his job making fiberglass pipes. She gets discounted diabetic medication from a charity, but came to the clinic to ask a doctor about blood in her urine.

Under the law, she would qualify for Medicaid. Her eyebrows shot up as the law was described to her. "If they put that law into effect, a lot of people won't need disability," she said. "A lot of people go onto disability because they can't afford health insurance."

States like Tennessee have kicked a lot of people off Medicaid in recent years -- in Tennessee, you may now be ineligible if you earn as little as $10,000. Conversely, the federal disability rolls have swelled since the financial meltdown and have been rising steadily since the 1990s. Investor's Business Daily reported on April 20 of this year:

Obama, four years later

Like Alec MacGillis, I am reassured that Obama's 'populism' on the campaign stump, as unveiled in two rallies this weekend, is of the signature Obama variety - -"communitarian" in MacGillis' apt characterization, "less 'us versus them' than 'all together now.'"  That doesn't mean not hitting Republican policies hard any more than it did in 2008  -- it was only in the thick of failed budget negotiations in 2011 that Obama pulled his punches with regard to the GOP agenda.

One difference with 2008 thus far, though. Obama's pitch then was to reform our politics as well as our policies -- his promise to find common ground with Republicans chimed harmoniously with his assertions that Americans had historically committed themselves to the common good. Now, it's only his policies  -- not the political process in which the rival parties are bound to work -- that he is presenting in a "communitarian" vein -- balancing capitalism's individual incentives with collective effort that leads to shared prosperity. There was no "sometimes the other side may have a point"-ism.