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Obamacare and the Medicaid Expansion: How Does Your State Fare?
Posted By Drew Gonshorowski On March 5, 2013 @ 1:28 pm In Featured,Health Care | No Comments
The Medicaid expansion is touted by proponents of Obamacare as a “no-brainer .” While it is true that some states may see projected savings, it is erroneous to claim that this experience applies to every state.
Proponents predict that by expanding Medicaid states will be able to reduce payments to health care providers, such as hospitals, for uncompensated care. As a matter of fact, nationally, the opposite is true:
Of course, even these savings are highly speculative. They assume that uncompensated care costs actually decrease under a Medicaid expansion. Analysis of other states shows that this is not always the case. In fact, in Maine, uncompensated care continued to grow .
Furthermore, the assumed reductions in state supplemental payments to providers for uncompensated care are conditional on state lawmakers enacting explicit payment cuts. Depending on policies adopted by state lawmakers, those reductions could be higher or lower—or even zero—if a state does not enact payment cuts.
As Heritage analyst Ed Haislmaier  points out:
Under Obamacare, it is even more implausible to assume states would be able to cut uncompensated care funding. That’s because any state payment cuts would have to be imposed on top of Obamacare’s federal payment cuts. Obamacare cuts federal Medicaid “Disproportionate Share Hospital” (DSH) funding by $18.1 billion and Medicare DSH funding by $22.1 billion over the years 2014–2020.
Therefore, Haislmaier predicts, “governors and state legislators should expect their state’s hospitals and clinics to lobby them for more—not less—state funding to replace cuts in federal DSH payments.”
The Medicaid expansion represents a massive increase in federal and state spending. Although some claim that states could experience savings, it is clear that this is the exception, not the rule. Expanding Medicaid will ultimately cost states in the long run.
See the breakdown for each of the 50 states and the District of Columbia here:
A Kaiser Foundation/Urban Institute study from November 2012 projected the cost and coverage effects of the Medicaid expansion  over the first nine years (2014–2022). Of particular interest to state lawmakers are the study’s projected changes in state expenditures associated with each state adopting the Medicaid expansion. However, the Kaiser/Urban study reports only the net effects for each state on a cumulative basis.
The Heritage microsimulation model was used to replicate the Kaiser/Urban study—applying the same assumptions and using the same data sources—but reported the results in disaggregated form.
Consistent with the Kaiser/Urban methodology:
It is important to note that the assumed reductions in state supplemental payments to providers for uncompensated care are not automatic but are conditional on state lawmakers enacting explicit payment cuts.
The estimates also do not reflect the fact that many states could achieve additional savings by reducing Medicaid income eligibility for adults to federally mandated minimum levels, thus making the affected individuals eligible instead for federally subsidized exchange coverage.
Both provider payment cuts and changes to income eligibility require separate policy decisions by state lawmakers. Furthermore, state lawmakers could make changes to either or both policies regardless of whether they elect to implement the Medicaid expansion.
Like the Urban Institute’s Health Insurance Policy Simulation Model, which was used to produce the original study, Heritage’s microsimulation model is comprised of data from the Current Population Survey and Medical Expenditure Panel Survey.
Article printed from The Foundry: Conservative Policy News Blog from The Heritage Foundation: http://blog.heritage.org
URL to article: http://blog.heritage.org/2013/03/05/obamacare-medicaid-expansion-state-by-state-charts/
URLs in this post:
 no-brainer: http://decaturdaily.com/stories/Alabama-debating-Medicaid-expansion,114244
 Image: http://blog.heritage.org/wp-content/uploads/CP-medicaid-expansion-NY-winner-total.jpg
 continued to grow: http://www.flsenate.gov/PublishedContent/Committees/2012-2014/SPPA/MeetingRecords/MeetingPacket_2026.pdf
 Ed Haislmaier: http://www.heritage.org/research/commentary/2012/09/deconstructing-state-savings-from-expanding-medicaid
 Alabama: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/alabama
 Alaska: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Alaska
 Arizona: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Arizona
 Arkansas: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Arkansas
 California: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/California
 Colorado: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Colorado
 Connecticut: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Connecticut
 Delaware: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Delaware
 District of Columbia: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/district-of-columbia
 Florida: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Florida
 Georgia: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Georgia
 Hawaii: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Hawaii
 Idaho: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Idaho
 Illinois: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Illinois
 Indiana: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Indiana
 Iowa: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Iowa
 Kansas: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Kansas
 Kentucky: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Kentucky
 Louisiana: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Louisiana
 Maine: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Maine
 Maryland: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Maryland
 Massachusetts: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Massachusetts
 Michigan: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Michigan
 Minnesota: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Minnesota
 Mississippi: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Mississippi
 Missouri: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion//Missouri
 Montana: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Montana
 Nebraska: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Nebraska
 Nevada: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Nevada
 New Hampshire: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/New-Hampshire
 New Jersey: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/New-Jersey
 New Mexico: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/New-Mexico
 New York: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/New-York
 North Carolina: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/North-Carolina
 North Dakota: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/North-Dakota
 Ohio: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Ohio
 Oklahoma: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Oklahoma
 Oregon: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Oregon
 Pennsylvania: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Pennsylvania
 Rhode Island: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Rhode-Island
 South Carolina: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/South-Carolina
 South Dakota: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/South-Dakota
 Tennessee: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Tennessee
 Texas: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Texas
 Utah: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Utah
 Vermont: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Vermont
 Virginia: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Virginia
 Washington: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Washington
 West Virginia: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/West-Virginia
 Wisconsin: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Wisconsin
 Wyoming: http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/Wyoming
 Download all the charts here.: https://thf_media.s3.amazonaws.com/2013/pdf/Medicaid_ 50states.pdf
 cost and coverage effects of the Medicaid expansion: http://www.kff.org/medicaid/upload/8384.pdf
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