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Medicaid Expansion Brings Almost 12 Million Into Ranks of Insured, CMS Reports


The number of Americans finding coverage through Medicaid expansion equals those who signed up for private insurance on the exchanges, according to new data. Montana has just passed legislation to become the 29th state to expand Medicaid.

As of February, 11.7 million more Americans have health coverage through Medicaid or the Children’s Health Insurance Program under the Affordable Care Act (ACA), data from CMS show.

This total is separate from the 11.7 million consumers who signed up for private insurance on the exchanges. February’s total includes 560,000 new enrollees from the month of January 2015.

When Congress passed the ACA, the law called for all states to expand Medicaid to bring coverage to those households earning between 100% and 138% of the federal poverty line. However, the 2012 US Supreme Court ruling that upheld the individual mandate, the core of the law, also gave states the right to decide whether to expand Medicaid.

Thus far, 28 states have expanded Medicaid, and a 29th, Montana, is poised to do so. Democratic Governor Steve Bullock signed legislation April 29, 2015, that passed with support from lawmakers in both parties. CMS still must officially grant a waiver for some of the law’s provisions.

Left behind are an estimated 4 million people in a “coverage gap,” according to the Kaiser Family Foundation. Because the law did not anticipate that some states would opt out of expansion, it does not allow premium subsidies to go to consumers in this income bracket.

Data in the CMS report show that Medicaid enrollment grew by 27% in expansion states, compared with 8% in those that did not expand Medicaid. Researchers are already reporting on the health effects of this divide: in March, the journal Diabetes Care published a study that showed states that expanded Medicaid diagnosed 23% more new cases of type 2 diabetes than those without expansion.

Florida’s battle over Medicaid expansion has divided Republicans in its legislature and put business and hospital leaders in opposition to Republican Governor Rick Scott, who at one time supported expansion but has changed his mind. Last week, Scott sued to force CMS to continue paying a $1.3 billion share to the state’s Low-Income Pool, which pays hospitals that care for large numbers of uninsured. CMS has said the LIP in its current form cannot continue; instead, expanding Medicaid would give many of these consumers access to coverage.

There is some support for that argument: Forbes reports that hospitals are seeing sharp declines in patients who cannot pay their bills. Some critics of Medicaid expansion, however, say that because reimbursement rates are so low, many uninsured still go to the emergency room because primary care doctors will not accept new Medicaid patients.

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