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You are here: Home / Anderson On Health Insurance / Apples, bananas and oranges or Case Mixture

Apples, bananas and oranges or Case Mixture

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Charles Gaba has a good post on the Medicaid Trap due to the Supreme Court making Medicaid Expansion voluntary and an ad-hoc work-around that is in play.  He lays out a reasonable scenario, but I saw something that to me is the equivilent of nails on a chalkboard as he started to draw policy conclusions together.

Besides, according to KFF.org, the Medicaid program costs $3,263 per adult in Texas ($6,526 for two adults), which means that it would actually cost the taxpayers less to enroll this couple in Medicaid anyway ($6,526/year vs. $6,852).

I really don’t like these types of simple straight up comparisons, especially in states where the Legacy Medicaid eligiblity restrictions were very tight.  Texas has very tight limits where healthy adults that were no on Social Security Disability (SSI) with no kids had no chance of qualifying for Medicaid.  People in nursing homes and people on SSI qualified for Texas Medicaid.  The pool of people who are in the Medicaid Trap is most likely not directly comparable to the current pool of reasonably healthy adults who are not on SSI nor in nursing homes but are still on Texas Medicaid.  My bet is the currently enrolled pool is younger, more female, and much poorer with far fewer assets (ie a working car etc) than people who would only qualify for Texas Medicaid expansion.

The expansion pool is probably older (more expensive), more male (slightly cheaper), and has a few assets/more stability (slightly cheaper).

A direct comparison on costs can’t be done unless there is a damn good idea of the actual or projected utilization profiles of the populations.  Actuaries will do that as that is their job, but it can’t be done at a glance.

Reader Interactions

12Comments

  4. 4.

    raven

    Richard’s posts require, you know, reading. Other posts lend themselves to just jumping in and saying dumb shit without even looking first.

  5. 5.

    MomSense

    @Richard mayhew:

    Richard are you following the broohaha in Maine between LePage and the DHS vs. our Attorney General and the US govt. over LePage’s attempts to cut medicaid services from non-disabled, low income 19 and 20 year olds?

    In a nutshell the Federal Appeals Court denied the request to cut them off medicaid and now LePage wants to fight it at the Supreme Court but our Attorney General has refused to bring the case because she questions the legal merit. So the governor’s administration is hiring outside legal counsel to pursue this.

    Is this another attempt to try and chip away at Medicaid?

  6. 6.

    Mike J

    @raven: Exactly. I don’t comment as often on Richard’s posts, even though they’re the one I read most closely. He’s an actual expert. When Cole says something moronic I don’t feel any need to second guess myself when I tell him how stupid he is.

  7. 7.

    Doug r

    Can’t you claim your income as being just at the Medicaid limit and qualify for ACA subsidies? If your income is a little short they don’t penalize you?

  8. 8.

    Richard Mayhew

    @Doug r: Yep — as long as it is good faith(ish) estimate of your income

    There will be a follow-up post on this subject either tonight or sometime tomorrow.

  9. 9.

    Pogonip

    @raven: And thank God for that. :D

    What’s with the paucity of jump-in-and-say-something posts lately? Have they all got the flu or something? I guess we readers will have to fill in. So…

    What’s on the agenda?

  10. 10.

    Pogonip

    @MomSense: Probably. (I’m not Dick, but I was pretty sure I had the answer; hope you don’t mind.)

    How is your roof holding up?

  11. 11.

    Xjmueller

    A brief pedantic interlude…
    Social Security Disability benefits are not SSI. Both are based on disability findings and both are administered by SSA. Social Security disability insurance benefits have a work and earnings requirement. SSI Disability is a welfare/income supplement program. It’s an important distinction, particularly vis a vis other safety net programs like Medicaid. Social security disability benefits come with Medicare after two years of disability. You can get both SS and SSI disability if the social security benefit is less than the SSI max. That is all.

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