Top 10 Transparency States and the Potential ACA Fallout

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The healthcare community’s favorite hot topic, the Affordable Care Act and its various provisions are set to take effect by next year, but what that means for Americans by state is yet to be seen. One of the most controversial provisions has to do with Medicaid expansion.

Here’s a quick overview of what expansion will entail:

  • Will cover all citizens earning up to 138% of the federal poverty level (FPL)
    • Up to $15,417 annual salary for an individual
    • Up to $26,347 annual salary for a three-person household
  • Provide subsidies to assist citizens making up to 400% of the FPL purchase private insurance from the ACA’s newly created insurance exchanges
    • Up to $44,687 annual salary for an individual
    • Up to $76,368 annual salary for a three-person household
  • Will cover low-income, fully-abled individuals and families, as well as low-income individuals with chronic or mental disabilities who did not qualify under the previous Medicaid system

Last June, the U.S. Supreme Court overturned the mandatory Medicaid expansion provision, instead leaving it up to individual states to decide whether or not to opt-in to the program. According to this Health Affairs Blog article, 26 states have indicated their intentions to opt-in to expansion, while the remaining states are either leaning toward opting-in, leaning toward opting-out, or fully opting-out. A new study finds that if the states that are planning to opt-out of the expansion will, on average, leave 3.6 million more people uninsured, lose $8.4 billion in federal assistance for care, and incur $1 billion in additional expenses for care that would have been covered by the expansion.
Let’s break these numbers down individually by state, taking a look at the states that conduct the most price transparency searches or have high populations of uninsured patients, to see how their states’ decision could affect them.
 
New York

New York: Putting It Into Perspective
New York: Putting It Into Perspective

Putting it into perspective: One million people gather in Times Square to watch the ball drop every year. More than twice as many people are currently uninsured in New York.
New York is leaning towards opting-in, which makes sense because they are a high-rolling state when it comes to Medicaid expenses. Of the New York state population, 22% are currently covered by Medicaid—which is the fourth highest in the nation— and 20% are uninsured. If the state decides to opt-in, it is estimated that the uninsured population will drop from 2.36 million to 1.2 million.
 
Mississippi
Mississippi intends to opt-out of the Medicaid expansion program. The state’s population includes 20% covered by Medicaid and 19% with no form of coverage; both numbers among the top 10 highest in the country. If they opt-out of expansion, it is estimated that the state’s uninsured population will only fall by 81,000 rather than the 240,000 it could cover if the state opted in.
 
Florida
New York: Putting It Into Perspective
Florida: Putting It Into Perspective

Putting it into perspective: 3.6m international visitors travel to Orlando each year, not quite as much as the 3.77m uninsured people in the entire state of Florida.
Florida is planning to opt-in, good news for the sixth highest Medicaid spender. The Florida population includes 14% covered by Medicaid and 20% uninsured—tied for fourth-highest uninsured population in the country, along with Louisiana and Georgia. If Florida opts-in, it is estimated the state’s uninsured population will fall from 3.77 million to 1.9 million.
 
Nebraska
Nebraska is leaning towards opting-out. The state’s population includes 11% covered by Medicaid—the sixth lowest in the country—and 13% uninsured, also among the lower ranks in uninsured populations. If they do opt out, Nebraska could lose out on 64,000 additional people that could be insured if the state opts-in.
 
California
California: Putting It Into Perspective
California: Putting It Into Perspective

Putting it into perspective: Almost a million people attend the Rose Parade in Pasadena each year, which means it would take 7.5 parades to have each uninsured Californian attend.
California, the country’s second-largest Medicaid spender, intends to opt-in. California’s population includes 19% covered by Medicaid and 20% uninsured, among the top 10 in both rankings in the nation. By opting-in, it is estimated that their uninsured population will be approximately cut in half, from 7.43 million to 3.75 million uninsured.
 
Texas
Texas, the country’s third-largest Medicaid spender, intends to opt-out of Medicaid expansion. Texas’ population includes 16% covered by Medicaid and 24% uninsured—the highest uninsured population in the country. By opting-out, the state’s uninsured may only drop from 6.08 million to just under 5 million, when they could cut it almost in half to 3.08 million if they opted-in.
 
Georgia
Georgia: Putting It Into Perspective
Georgia: Putting It Into Perspective

Putting it into perspective: The Georgia Dome can hold just over 71,000, which means you’d need 27 Georgia Domes to hold all 1,862,000 uninsured Georgians.
Georgia intends to opt-out of the Medicaid expansion. The state’s population includes 14% covered by Medicaid and 20% uninsured—tied for fourth-highest in the country, along with Florida and Louisiana. By opting-out, it is estimated that the state will see a decline of less than a 20% in the uninsured population, rather than almost a 50% decline if they opted in.
 
Illinois
Illinois intends to opt-in to Medicaid expansion. The state’s population has 17% covered by Medicaid and 15% uninsured. By opting-in to Medicaid expansion, the state should see a drop of about 1 million, from 1.9 million to 967,000 uninsured.
 
Louisiana
Louisianna: Putting It Into Perspective
Louisianna: Putting It Into Perspective

Putting it into perspective: 200,000 beads are thrown each year at Mardi Gras, which means you’d need five Mardi Gras to have enough beads for every uninsured Louisianan.
Louisiana intends to opt-out of the expansion program. The state’s population includes 20% covered by Medicaid and 20% uninsured—tied for fourth-highest in the country, alongside Georgia and Florida. If they opt-out, the state should expect to see about a 20% drop in the uninsured population, versus a 50% drop if they opted-in.
 
 

Colorado

Colorado intends to opt-in to Medicaid expansion. The state’s population includes 13% covered by Medicaid and 14% uninsured. By opting-in, it is estimated that the state’s uninsured population will fall from 788,000 to 399,000 uninsured.
 

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