Chris Frenier and Adrianna McIntyre asked a very policy relevant question in JAMA Network Open:
When people get disenrolled from Medicaid, what happens to their coverage in six and twelve months
They used the Minnesota All Payer Claims Database to track where disenrolled Medicaid Enrollees have coverage in the next six and twelve months. The data source is probably one of the better ones nationally but it is still flawed as it is not able to require data from large self-insured employer groups so there is a lot of missingness nor does it track people who move out of state. But even with that, it still provides a lot of insight.
At six months, disenrolled kids have about a 50% chance of not being observed in the database. At twelve months, about 30% of the kids are not observed in the database. Some of this is known missingness. A lot is likely uninsurance. At a year, half the kids are back on Medicaid. Rushina Cholera, myself and other Duke co-authors found similar results in North Carolina during the same time period of this study. Adults have 50% missing from the database in six months and 40% missing from the database in 12 months.
The big and important thing as the country is currently redetermining Medicaid eligibility is the ACA marketplaces aren’t picking up a ton of new enrollments. About 5% to 6% of adults are enrolling in ACA plans and even fewer kids are enrolling in ACA plans after they lose Medicaid.
This is massively problematic.
Perhaps the enhanced subsidies will help, but that is a big hope for modest money and behavioral frictions that have to be overcome.
With red of control of NH where we live, the governor and legislature are looking to disenroll as many people as possible. It’s hard to see the charts and real numbers that will be the consequence. New Hampshire participates in the expansion under the ACA, but does it on a two year basis with renewals. There has been a push to make it permanent. At the hearing to make it permanent, a large number of the state medical groups and organizations, along with other social service groups, all showed up to advocate for making the expansion permanent. Everyone that testified was for making it permanent, except for one out of state person from the Koch institute, who advocated for repealing the expansion, and if not that keeping it a two year renewal. Guess which voice is carrying the day. So much for representing your constituencies and locality.
Hmm…Maybe a system where everybody has the same coverage with the premiums maybe adjusted if your income is high enough, otherwise free?
@Doug R: get me the votes…
I had some thoughts, but I don’t have the votes, so I’ll just step back out.
I think my daughter in WA is going to be toggling between Medicaid and too-expensive insurance when she finishes school and works as a private contractor on boats. She estimates it will cost her $500/ month, and may not offer many providers.
She had surgery two years ago, and her coverage ended a month before the surgery, so she has a bill hanging over her. I suggested challenging it, and she told me how difficult it is to do so without reliable wifi, out there on the Olympic Peninsula.
I hate to see her get so discouraged about this. She is a hard worker; takes her jobs seriously. I had hoped the ACA would work out better for her than it has.
@wenchacha: I don’t know how much help Washington State’s Office of the Insurance Commissioner can be, but it might be worthwhile for your daughter to try contacting them. They are pretty fiercely on the side of the consumer.
@CaseyL: Thanks! I will make the suggestion to her.
One of the problems is that Medicaid ends when you start getting a salary, but with many jobs being temp to hire, where insurance doesn’t kick in for a while, or if the job doesn’t pan out or has irregular hours… The insurance system isn’t set up for the actual jobs at the lower end of the pay scale. Or how employee insurance works.