Report: Full ACA Implementation Would Lead to 18M More Insured

If all 50 states expanded their Children's Health Insurance Program and Medicaid programs as outlined under the Affordable Care Act, nearly 18 million U.S. residents would become insured and the uninsured rate would fall below 15% in all states, according to a recent report from the Kaiser Family Foundation and Urban Institute, Modern Healthcare reports (Ross Johnson, Modern Healthcare, 8/6).

Background

Under the ACA, U.S. residents with incomes up to 138% of the federal poverty level are eligible for Medicaid. However, the U.S. Supreme Court last year ruled that states could opt out of the expansion. For states that opt in, the federal government will cover 100% of the cost of the expansion until 2016, after which the federal share will decline gradually until it reaches 90% in 2020 (California Healthline, 6/4).

Report Details

For their analysis, researchers used data from the Urban Institute's American Community Survey - Health Insurance Policy Simulation Model, which simulates individuals' decisions based on their responses to proposed policy changes, such as:

• Expanding Medicaid;
• Offering new health coverage options;
• Providing subsidies to purchase coverage; and
• Implementing various insurance market reforms.

The survey polled about 7.5 million people from 2008 through 2010, and the data were combined to provide a snapshot of coverage trends at the state and local levels. According to a summary of the study, the data were reweighted so that the distribution of the population -- by gender, age and race -- matched 2011 population estimates from the U.S. Census Bureau.

The study found that with full implementation of the ACA, which would involve expanding CHIP and Medicaid, the national uninsured rate would fall by about 47%. According to the study, states' uninsured rates currently vary from under 10% in Massachusetts and Hawaii to more than 25% in Texas and Nevada. While every state would see their rates fall below 15% with full expansions of CHIP and Medicaid, at least seven states would see their rates fall under 6% (Kaiser Family Foundation/Urban Institute study, July 2013).

Spurring All States To Expand Medicaid Could Be Challenging

About two dozen states have agreed to expand their Medicaid programs under the ACA, and encouraging more of the remaining states to do the same could be challenging as many of them have "gone through pitched political battles" over the issue, Modern Healthcare reports.

For example, Missouri's GOP-controlled Legislature blocked Democratic Gov. Jay Nixon's plan to expand Medicaid coverage to about 250,000 residents. Several other states -- including Florida, North Carolina and Ohio -- have faced similar situations, where Republican-led Legislatures have rejected their governors' plans to expand Medicaid.

However, Arizona in June became an exception after Gov. Jan Brewer (R) signed a fiscal year 2013-2014 budget measure with an expansion plan that was approved by a divided GOP-led Legislature (Modern Healthcare, 8/6).