Friday, November 15, 2013

ACA Medicaid sign-ups lead the way -- even in states rejecting the expansion

The feds released the official enrollment stats for the first month of exchange and Medicaid sign-ups (shown in the last two columns of this handy spreadsheet compiled by the Dailykos commentator Brainwrap) Much of the focus has been on two things. First, commentators have been arguing about the portents of how many people have signed up for the exchanges, noting that it both has roughly matched Massachusetts' sign up rate and that sign-ups have fallen short of federal projections. The other strand has noted that the Medicaid sign-up rates have been a success.

But there's something else that's interesting in those Medicaid numbers as well -- lots of new people are getting covered in states that have refused to expand Medicaid. Of the roughly 392,000 people who enrolled Medicaid between October 1 and Nov. 2, about 111,000 enrolled in states that aren't expanding.

"Wait, how does that work?" you say. "I thought Rick Perry and people like him were going to stop that sort of nonsense at the state line."

But he can't. These are people who were eligible for Medicaid before the ACA, but either didn't know they were eligible, or gave up going through their state's onerous application procedures.The ACA streamlines these procedures through its "no wrong door" policy of making states provide multiple ways to apply for Medicaid -- including through or the equivalent state portal. The Supreme Court decision that made expansion optional didn't touch these improvements.

I wrote about this about a month ago:
Better administrative procedures aren’t a cure all. According to Kaiser Foundation's numbers, 8.4 million people won’t be covered under the Medicaid expansion in the foreseeable future in states that opted out, thanks to the Supreme Court’s decision.  (about 5.1 million won't even be eligible for the subsidies on the exchanges, while the rest will at least have those).
But if Kaiser’s analysis is right, standardizing and easing application procedure across the board will significantly increase enrollees – by roughly 2 million people across the states that haven’t yet accepted the Medicaid expansion (more than 500,000 in Texas alone).
Texas had 11,000 new people sign up for Medicaid last month thanks to these changes. Again, this isn't a cure-all -- states that aren't expanding Medicaid have about 51 percent of the currently uninsured population and only 28 percent of the new Medicaid sign-ups. However, by cutting punitive bureaucracy and making it easier to apply, the ACA is already helping hundreds of thousands of poor people in the red states, despite the efforts of their reactionary governors.

We've got a long way to go, but things are getting better.

Now get that federal Web portal working, Obama.

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