The Trump administration will not give Utah or other states generous federal funding to partially expand their Medicaid programs under the Affordable Care Act, funding that Utah hoped to receive after the administration earlier this year authorized the state to move forward on an expansion of the government health insurance program
This is important as Utah was about to file a waiver to ask for the enhanced matching rate instead of their standard 70% rate for expanding Medicaid to only 100% FPL. Utah had a complex set of interlocking waivers that the state legislature approved to spend more money to cover fewer people compared to a full expansion that voters had approved in November 2018. Now those waivers are likely to fall apart, and after a complex series of unfortunate events, a standard expansion with work requirements will most likely be implemented in Utah.
Utah and Wisconsin have expanded Medicaid to 100 percent FPL so that all citizens of these states earning less than 400 percent FPL are eligible to receive some financial assistance for medical insurance. Utah and Wisconsin are receiving neither enhanced federal funding nor the rate reduction benefits of a full expansion. Other states are also investigating partial Medicaid expansions, which has significant legal and financial implications….
Adrianna McIntyre and I also poked at this idea of a partial Medicaid Expansion at the Health Affairs blog:
These silver-loaded policies only benefit those exchange enrollees who qualify for federal tax credits. The proposal by Utah’s legislature succeeds in expanding Medicaid to only 100 percent of the federal poverty line, keeping the 100-138 percent FPL cohort in the exchange means a sicker risk pool with higher premiums for unsubsidized enrollees, relative to a world where the state fully expands the program to 138 percent FPL….
Furthermore, subsidizing individuals to enroll in private plans is more expensive than covering those same people on Medicaid. States are likely to find the more expensive option attractive, because they do not directly bear the burden of paying the federal tax credits that make these plans affordable for lower-income households. By contrast, Utah would be responsible for shouldering 10 percent of the cost of the Medicaid expansion population from 2020 forward. Partial expansion is thus a clear winner from the state budgeter’s perspective, but a potential loser for the federal government—partial expansion is only a less expensive proposition if fewer people enroll in coverage.
The short run, limited effect is that Utah is highly likely to go to a full expansion. The intermediate run effect is that several states that were potentially considering partial expansions as a viable pathway forward if they received the enhanced 90% ACA match for only the sub-100% FPL population won’t go move forward.
J R in WV
I must confess I cannot understand how states with referendum requirements can have voters pass a constitutionally authorized referendum, only to have the state legislature either ignore the new law passed by referendum, or in the recent case in Florida, to pass legislation clearly intended to thwart the purpose of the legally passed referendum???
Shouldn’t the justice system in those cases be able to punish legislators who refuse to obey the newly passed referendum legislation? Do actual voters count at all? Seems the answer is nope. Democracy is over now, folks! It’s just what you can afford to buy — if you can’t purchase a sufficient number of legislators, screw your referendum. Sad to have to believe this is now the case, but here we are.
rikyrah
So,
do you think this is a good thing, or a bad thing?
Barbara
I started being asked this question as early as 2013. The Medicaid expansion criteria are statutory, and the federal government can’t waive the expansion FPL thresholds. Waiver. Would. Lose. In. Court. Every. Time. Seriously, did a seminar with Medicaid actuaries and this was basically the only thing they wanted to know. It’s not even an “on the one hand, on the other hand” kind of thing. There is no other hand. This is the law. Utah and every other state should get a grip and stop pretending that the terms are other than they are.
Barbara
It was actually seven years ago:
In other words, a waiver is supposed to help states provide minimum levels of coverage more efficiently, or reflect a reasonable expansion. It was never intended to allow states to fail to meet minimum thresholds required by federal law.
Barbara
@rikyrah: The case for why it’s a bad thing is that people above 100% FPL can get subsidized exchange coverage, whereas, people between the current state Medicaid threshold and 100% FPL cannot, so “partial expansion” would help the people who need help the most.
The problem with this view is that the ACA was designed so that people between 100% and 138% of the FPL could gauge their own circumstances and decide whether they need the kind of low cost-sharing benefit that Medicaid provides (e.g., they work part-time and have some medical needs that end up making their income less than stable) or whether they are just young and healthy and therefore, likely to be moving into a situation that makes exchange coverage likely temporary. Thus, states are trying to “rework” the congressional enactment to their own liking, after having fought tooth and nail to overturn it altogether. They have a political choice to make, to leave their vulnerable citizens high and dry or not. I don’t see why we all have to beg them to care about their own constituents.
And the reason to believe that most of this is just bad faith political grandstanding is that many of these are the same states that are clamoring for work requirements and what not. Basically, they hate poor people and they will take ever opening to deny as many people as possible assistance.