Medicaid Expansion Drives Down Uninsured Rates in Colorado

Awareness of the ACA has brought out more recipients eligible for Medicaid than the state knew it had.

Colorado has seen was the nation’s most dramatic drops in the rates on Americans without health coverage, and Medicaid expansion has been a key part of equation.

According to the Colorado Health Access Survey, the uninsured rate stood at 13.5% in 2009, and rose as high as 15.8% in 2011 before dropping to 14.3 in 2013, the year before enrollment through its exchange became possible under the Affordable Care Act (ACA).

Requirements for mandatory coverage coupled with the ACA’s provision to let states expand Medicaid to household up to 138% of the federal poverty line had helped Colorado cut its uninsured rate to 6.7%, one of the biggest drops nationwide.

Few states have embraced Medicaid enrollment and expansion as wholeheartedly as Colorado has, and state officials themselves are surprised at how many have signed up. They are particularly proud at how low the uninsured rate is among children—it’s now down to about 2.5%.

The publicity around the ACA, including who qualifies for Medicaid, has created a phenomenon even in states that resisted expansion: in places like Alabama and Mississippi, where “Obamacare” is politically unpopular, the availability of help to assist people with enrollment has allowed some who had no idea they qualified for Medicaid to obtain benefits for the first time. Alabama has seen a surge in Medicaid enrollment, although it resisted expansion.

Matt Salo, executive director of the National Association of Medicaid Directors, told Kaiser Health News, that many states underestimated the impact of expansion and the effect of ACA on Medicaid. “It’s hard to forecast what actually happens when you change a lot of pieces to an interconnected system,” he said. States are signing up more people than they assumed lived in the state, he said. Colorado is among those states.

What’s also hard to predict is whether the bold push to sign up enrollees will save money over the long-term. Colorado Governor John Hickenlooper initially thought the state would cover an additional 160,000 new Medicaid clients over 10 years without costing the state a dime. Already, the Colorado Health Access Survey finds the state has signed up 450,000 recipients, and is putting a huge effort into preventive services.

Sue Birch, head of Colorado’s Medicaid programs, insists total cost of care per person is down 9% since expansion started and that more patients with chronic conditions are gaining access to care.

The state has found, however, that younger recipients tend to be underinsured, which means they are not buying enough coverage to sustain them through a serious illness. The most common reason given is the pricetag. Meanwhile, premium increases for 2016 in a few states have been substantial, including some above 20%, as insurers figure out what it truly costs to care for this new population.

Like other states, Colorado has seen its share of Medicaid patients who are finally receiving care after years of not seeing a doctor at all—and for a while that will bring higher costs and heart-wrenching tales of what might have been.

Physician’s assistant Jaime Vader told Kaiser Health News about a 61-year-old woman who came in to her clinic with a suspected bladder infected and was diagnosed with cervical cancer. The woman had not seen a doctor for well care in a decade, and her cancer could have been prevented.

The case is typical. “We’ve always had a lot of really sick people. There are just more of them.”