Obamacare Success Story? Millions More Enrolled in Medicaid and Food Stamps — Government Dependency On The Rise — 30 Million Seeking Full Time Jobs — Wonder What Failure Looks Like? — Videos
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Segment 0: Obamacare Success Story? Millions More Enrolled in Medicaid and Food Stamps — Government Dependency On The Rise — 30 Million Seeking Full Time Jobs — Wonder What Failure Looks Like?
How Medicaid & Obamacare Hurt the Poor – and How to Fix Them
Medicaid Sign Ups Outnumber People Enrolling In Paid For Obamacare Plans Lou Dobbs
CBS: ObamaCare System Threatened From High Medicaid Enrollment In Many States
Obamacare: Medicaid enrollment outpacing private insurance could ca
Stimulus, Obamacare & The New Republic: May 2013 Reason Mag
Your Doctor Is Not In? ObamaCare may put your doctor out of business.
83% of Private Practice Doctors Quiting Due to Obamacare Main Stream Media Keeping Quiet
Obamacare Has Always Been About Killing Grandma & Grandpa
Government Payouts – Nick Gillespie
ObamaCare Event In Arkansas Hands Out Condoms As Prizes
Is There a Silver Lining to the Supreme Court’s Obamacare Decision?
The History of Medicaid (According to Frank Thompson)
47 Years of Medicare & Medicaid
Heritage Hangout: Obamacare’s Medicaid Expansion
Why new Medicaid enrollment is soaring
States are reporting far higher enrollment in Medicaid than in private insurance since the Affordable Care Act exchanges opened Oct. 1. In Maryland, for example, the number of newly eligible Medicaid enrollees is more than 25 times the number of people signed up for private coverage.
Even some Medicaid experts say they are surprised at the early numbers.
A Stateline survey of the 25 expansion states and the District of Columbia provides clear explanations for the strong Medicaid rollout so far.
The biggest reason for the initial jump in Medicaid enrollment is that hundreds of thousands of people in the expansion states have been pre-qualified for expanded Medicaid because they are already enrolled in low-income state health care. Illinois, for example, will roll over 100,000 Cook County residents who have received expanded Medicaid benefits since 2011.
Another reason for the big numbers is aggressive outreach campaigns in many states, including mailings to residents enrolled in other safety net programs. Oregon, for example, signed up 70,000 enrollees in October by contacting residents who receive food stamps.
A much smaller number of people in expansion states are also signing up on state exchanges and Medicaid websites. The federal government has not yet released the number of Medicaid applications filed on federally-operated exchange sites in the 34 states that are not running their own exchanges.
To be sure, the rush to enroll in Medicaid indicates a strong demand for health care coverage. But the early spike is more a function of states’ proven ability to find, educate and enroll low-income residents than an indication of an imbalance with healthier people who can afford insurance, as has been suggested.
It is important to note that early enrollment numbers reflect so-called “low hanging fruit,” said Matt Salo, director of the National Association of Medicaid Directors. Future increases are expected to be smaller.
The states that chose to expand Medicaid, Salo said, are predisposed to aggressively reach out to potential beneficiaries. “Most have been more committed to Medicaid than the other states,” he said.
After the U.S. Supreme Court ruled last year that Medicaid expansion was up to states, the Congressional Budget Office downgraded its original projection that 13 million people would qualify for expanded Medicaid in 2014 and 17 million by 2020. Now, the federal estimate is 7 million by the end of 2014 and 11 million by 2020.
Stateline‘s survey indicates at least 1.5 million people have already signed up or have been pre-qualified for expanded Medicaid in the 19 states that provided counts. Expected total enrollment in those states is 3.7 million.
Following are the details available as of Nov. 5:
Arizona: The number of new applications is not available at this time. In total, Arizona expects 57,000 people to qualify for its expanded Medicaid program. In addition, the state expects 240,000 more individuals to enroll in its existing Medicaid program for childless adults with incomes at or below the federal poverty level ($11,490). Enrollment in that program was frozen in 2012 and currently totals 70,000.
Arkansas: Arkansas has received 70,595 applications for its expanded Medicaid program. Of those, 3,672 came through the state’s existing Medicaid website, 1,785 were paper or phone applications, and the rest were positive responses to a mailing to 132,000 households that receive food stamps. Ultimately, the state expects about 250,000 uninsured residents to qualify.
California: California plans to release enrollment numbers from its state-run website in mid-November. Newly eligible enrollment in expanded Medicaid is expected to total about 1.4 million. Of that number, 600,000 people will come from the state’s early expansion program approved by the federal government in 2011.
Colorado: Colorado has qualified more than 25,000 adults for its expanded Medicaid program. Of that number, approximately 9,000 were on a waiting list for an existing Medicaid program that covers adults with extremely low incomes. Another 10,000 people enrolled in that program will also be transferred to expanded Medicaid coverage in January. Combined, that comes to 35,000 individuals, more than 20 percent of the 160,000 uninsured residents Colorado expects to be eligible for its expanded Medicaid program.
Connecticut: Connecticut has enrolled 3,550 new people in its expanded Medicaid program through its state-run exchange and Medicaid website. In addition, at least 48,000 enrolled in a state-run low income-health program have already been moved into expanded Medicaid. Connecticut expects a total of 55,000 expanded Medicaid enrollees in 2014.
Delaware: No new enrollment data is available yet. Delaware already provides Medicaid coverage for 30,000 adults with incomes up to the federal poverty level ($11,490). Its expanded Medicaid program is expected to cover another 30,000 people with incomes between $11,490 and 138 percent of the federal poverty level ($15,856).
District of Columbia: D.C. began expanding its Medicaid program in June 2010. By June 2013, nearly 50,000 new people were enrolled. The District has not estimated how many people will ultimately enroll in expanded Medicaid.
Hawaii: Hawaii has approved 6,100 applications for expanded Medicaid. By 2014, the state expects a total of 54,000 enrollees.
Illinois: The Illinois Medicaid agency has received 30,124 applications for expanded Medicaid through its existing website. Illinois has an exchange partnership with the federal government so applications are also being filed on the federally-run exchange. In addition to online applications, 46,000 people responded to an August mailing to 123,000 food stamp recipients. Illinois has enrolled 26,000 of those respondents and is processing the balance. In addition, 100,000 people in Cook County who participate in a limited early Medicaid expansion enrollment group will automatically be rolled over to the expansion program on Jan. 1. Projected enrollment is 342,000.
Iowa: No new numbers are available on Medicaid applications. In all, 150,000 uninsured Iowans are expected to qualify under the proposed expansion. About 63,000 residents with incomes up to 200 percent of the federal poverty level ($22,980) are currently enrolled in a Medicaid health plan with limited benefits. Most are expected to qualify for expanded Medicaid. Iowa has not yet received federal approval for its Medicaid expansion plan, which is similar to Arkansas’ so-called private option.
Kentucky: Kentucky has received 25,654 applications for expanded Medicaid through its state-run exchange. Ultimately, the state expects 308,000 low-income individuals to qualify.
Maryland: The number of applications from its state-run website is not yet available. However, Maryland has an existing, limited-benefit health plan known as Primary Adult Care (PAC) available to all adults with incomes up to 123 percent of the federal poverty level ($14,133). As of Sept. 30, enrollment in the plan was 82,423. Maryland expects enrollment in PAC to expand to 88,000 by Jan. 1, 2014, when the entire population will automatically convert to full Medicaid benefits. In addition, residents in a narrow income band (124 percent to 138 percent of poverty) can sign up for expanded Medicaid on the state exchange. Overall, Maryland expects 110,000 people to be enrolled by the end of 2014.
Massachusetts: No enrollment numbers are available at this time. As a result of its own health care reforms launched in 2006, Massachusetts has a 97 percent insured rate. Still, the state expects about 45,000 people to obtain Medicaid coverage as a result of the expansion.
Michigan: No enrollment numbers are available. The Michigan legislature approved Republican Gov. Rick Snyder’s proposed Medicaid expansion in September but postponed implementation until April 2014.
Minnesota: The federal government granted Minnesota special permission to enroll 84,000 individuals in the expanded Medicaid program in 2011. Another 2,496 newly eligible Medicaid beneficiaries completed applications on the state-run exchange in the first two weeks of October. Ultimately, Minnesota expects to cover 265,000 adults in its expansion. In addition, it is the only state that has opted to provide a so-called “Basic Health Plan” for people with incomes up to 200 percent of the federal poverty line ($22,980). Under the ACA, the federal government will pay 85 percent of the costs starting in 2015. That program is expected to grow to 160,000.
Nevada: No information is available at this time.
New Jersey: No information is available at this time.
New Mexico: New Mexico has approved 2,507 applications for expanded Medicaid through the federally operated exchange and its existing Medicaid website. In addition, 100,000 enrollees in two limited-benefit state health care programs will be rolled into the expanded Medicaid. New Mexico expects 130,000 people will be in the expanded program by 2015.
New York: No enrollment numbers are available yet. New York already covers parents with incomes up to 150 percent of the federal poverty line ($17,235) and childless adults with incomes up to the poverty line ($11,490).
North Dakota: The Medicaid agency has received 147 applications for expanded Medicaid. In December, the state plans to send letters to 36,000 households that receive food stamps or home heating assistance, inviting eligible adults to sign up for expanded Medicaid. Total enrollment in expanded Medicaid is expected to reach 32,000.
Ohio: The most recent state to expand Medicaid, Ohio expects to sign up 275,000 newly eligible Medicaid enrollees. Republican Gov. John Kasich sidestepped the state legislature and won approval for expansion Oct. 21 from an executive branch Controlling Board. The state has not yet begun enrollment. The Medicaid agency says it will announce soon when enrollment will begin.
Oregon: Oregon has approved 70,000 applications for expanded Medicaid. Its state-run website had some initial technical difficulties, but new applications were filed over the phone, in person and through the mail. The vast majority of enrollments came from a mailing in late September that went to 260,000 residents who either receive food stamps or have children enrolled in Medicaid. The state expects roughly 223,000 adults to be enrolled in its expanded Medicaid program by 2015.
Rhode Island: Rhode Island has approved 3,213 new applications for its expanded Medicaid program. Another 835 are in progress. Projected enrollment is 23,428.
Vermont: About 1,000 individuals have signed up for Medicaid on Vermont’s exchange or by submitting paper applications. In addition, 30,000 adults enrolled in two state-run low-income health plans will be rolled into the expanded Medicaid program. By 2015, Vermont expects enrollment to reach 160,000.
Washington: Through its state-run exchange and Medicaid sites, Washington has signed up 26,336 people. Another 30,000 people enrolled in a low-income health program will be automatically enrolled in expanded Medicaid, bringing the total to 56,336. The state expects 270,000 people to qualify by the end of 2014.
West Virginia: West Virginia has pre-qualified 52,056 residents for its expanded Medicaid program. Projected new enrollment is 63,000.
Since 1965, Medicaid has been the backbone of this country’s health care safety net. Jointly funded by the states and the federal government, Medicaid covers more than 58 million low-income Americans, including families, people with disabilities, and the elderly. Today, Medicaid provides coverage for almost 29 million children and pays for approximately half of all long-term care costs.
Medicaid is jointly funded by the states and the federal government. Federal law requires state Medicaid programs to cover certain categories of individuals and services. Beyond that, states have wide flexibility in the design and implementation of their Medicaid programs.
Medicaid Today: Even though Medicaid has helped millions gain access to health care, many low-income people have been left out. In 30 states, income eligibility for parents is set below 50 percent of poverty (in 2012, that’s an annual income of $9,545 for a family of three). In most states, adults without dependent children, no matter how poor, cannot get Medicaid coverage at all.
Medicaid Expansion: In 2014, as a result of the Affordable Care Act, states can get substantial federal funding to expand Medicaid to all residents with incomes at or below 133 percent of poverty, thus extending Medicaid coverage to individuals who have been left out of the program. [Note: Since 5 percent of income is not included—is “disregarded”—when eligibility is determined, the expansion, in effect, applies to those with incomes at or below 138 percent of poverty.]
For more on how Medicaid works today, and how it will work under the Medicaid expansion, see:
Medicaid Today: Generally speaking, each state receives matching dollars from the federal government, and those matching rates vary across the states from 50 to 76 percent. This means that, for every dollar a state spends on Medicaid, the federal government contributes between $1.00 and $3.17. Federal matching rates are based on the per capita income of the states, so states with lower per capita incomes get higher matching rates.
Medicaid Expansion: In 2014, the Affordable Care Act gives states the opportunity to expand their Medicaid programs to cover all individuals with incomes at or below 138 percent of poverty (see note above), an income of about $31,809 for a family of four in 2012. That will extend coverage to many low-income adults currently left out of the program and simplify eligibility determinations across the program.
Federal law requires states to cover certain categories of people in Medicaid. In general, there are six categories of so-called “mandatory” individuals: 1) children, 2) pregnant women, 3) very low-income parents, 4) the elderly, and individuals who are 5) blind or 6) disabled. Eligibility levels for these groups of people varies by income:
- Children under age six with family incomes up to 133 percent of the federal poverty level ($25,390 for a family of three in 2012)
- Children ages 6-19 with family incomes up to 100 percent of poverty ($19.090 for a family of three in 2012)
- Pregnant women with family incomes up to 133 percent of poverty
- Parents whose income meets the state’s AFDC (former welfare program) criteria in place as of July 1996
- People who are elderly, blind, or who have disabilities and who receive Supplemental Security Income (SSI) may have incomes up to 74 percent of poverty ($8,266 for an individual in 2012)
- Certain people with severe disabilities who would qualify for SSI if they did not work
Elderly individuals and people with disabilities whose Medicare premiums are paid by Medicaid through the “QMB,” ”SLMB,” and “QI” programs—generally speaking, these are individuals who have incomes below 150 percent of poverty
States have the flexibility to increase these income limits to allow more people to qualify for Medicaid for several general categories of people, as follows:
- Low-income children, parents, and pregnant women with family incomes above mandatory cutoff levels and up to whatever income limit the states decide
- People who are blind, elderly, or disabled with incomes above the SSI level but below 100 percent of poverty ($10,830 for an individual in 2010)
- Nursing home residents with incomes above SSI levels but below 300 percent of poverty ($32,490 for an individual in 2010)
- People with disabilities who work and have incomes above the SSI limit
- Medically needy individuals who require institutional care but who have incomes that are too high to qualify for SSI—these individuals can deduct the cost of their institutional care from their income in order to qualify for Medicaid
The Affordable Care Act requires states to maintain the Medicaid eligibility levels, policies, and procedures that were in place in March 2010 (the date the Affordable Care Act was enacted) until the state has an operational exchange.
Medicaid Expansion: In 2014, states can expand their Medicaid programs to cover virtually all individuals under the age of 65 with incomes below 133 percent of poverty. Income eligibility for those over 65 will remain unchanged. For those newly eligible through this expansion, the federal government will cover 100 percent of costs for 2014 through 2016, gradually falling to 90 percent in 2020. The federal contribution will remain at 90 percent thereafter. States have the option to implement this expansion sooner.
In states that expand Medicaid, the historic federal Medicaid matching formula will still apply to individuals who meet the Medicaid eligibility criteria in place as of December 1, 2009.
For more information on current state-by-state eligibility, see Medicaid and State Children’s Health Insurance Program (CHIP) Eligibility by State (May 2010) or Kaiser’s statehealthfacts.org and scroll down to “Medicaid Eligibility.”
Federal law requires states to provide a minimum benefit package in Medicaid. So-called “mandatory” benefits include physician services, hospital services, family planning, health center services, and nursing facility services. The benefit package for children is more comprehensive than the one for adults because federal law requires states to provide coverage for certain health screenings and services that are medically necessary. This requirement is called the Early and Periodic Screening Diagnostic and Treatment (EPSDT) benefit.
States are permitted to provide coverage for certain other health care services that are approved by the federal government. Such “optional” services include dental care, mental health care, eye glasses and vision care, coverage for prescription drugs, home health care, case management, and rehabilitation services. For a detailed list of what benefits state Medicaid programs cover, click here.
Medicaid Expansion: In states that take advantage of the Affordable Care Act’s Medicaid expansion, there are specific benefit requirements for those who are newly eligible. For those individuals, states must provide a set of essential health benefits. For more information on Medicaid’s essential health benefits, see Designing the Essential Health Benefits for Your State: An Advocate’s Guide.
- The Medicaid Resource Book (Kaiser Family Foundation, July 2002)
- Citizenship Documentation
- Deficit Reduction Act (DRA)
- Help for Consumers
Medicaid provides health coverage for low-income children and adults, medical and long-term care coverage for people with disabilities, and assistance with health and long-term care expenses for low-income seniors. More than 58 million people rely on Medicaid services today, and millions more will qualify for Medicaid when the provisions of the Affordable Care Act take effect in 2014.
Children receive health coverage through Medicaid and the state Children’s Health Insurance Program (CHIP). To learn more about CHIP, see the Children’s Healthsection.
This section of our website provides resources on Medicaid laws and regulations and keeps you up-to-date on the battle to sustain and improve this important program.
Medicaid Expansion Center
States that plan to expand Medicaid coverage in 2014 have much to do to prepare. In many states, advocates need support in making the case for expansion. The Medicaid Expansion Center offers information on everything from the Supreme Court decision’s effect on Medicaid to news from the Department of Health and Human Services (HHS), plus the best tools for helping your state make the most of the expansion.
Medicaid Defense Center
While some states move ahead to expand their Medicaid programs, the existing Medicaid program remains under fire at both the federal and state level. Many in Congress—and some governors, as well—seek to make deep cuts in Medicaid funding and to change the structure of the Medicaid program through proposals for block grants, per capita caps, and similar schemes. The Medicaid Defense Center features the latest news on the federal budget battle plus tools to help you fight for Medicaid funding in your state.
Obamacare Event Hands Out Condoms as Prizes
The Obamacare event took place at the University of Central Arkansas last weekend. It was hosted by a group called the Living Affected Corporation, which apparently has received a grant from the federal government to educate the public about Obamacare.
The event organizer spilled out a bag of condoms — as a couple whoops and hollers could be heard from the small crowd.
Then she says, “Ok, if anyone wants a paper application,” but she interrupts herself to pickup condoms that had fallen on the floor. “I have those as well.”
“So when you’re leaving, you can stop by my table and I’ll give you whatever — condoms — that box has a bunch in it. Anyway … Our corporation, LA Corp … And I’m waiting on my dental dams and female condom order that still hasn’t come in. If you ever need condoms, let me know because we have thousands — boxes of magnums, we get magnums a lot. So here is the prize table.”
The condom give-away was a training event with young Democrats, I’m told.
Is Obamacare on the rebound? Media turn to positive stories. (+video)
Positive headlines are creeping into the news coverage of Obamacare, amid a Democratic counteroffensive and signs the program could be turning a corner. But tough tests lie ahead.
Bit by bit, the media narrative around the travails of Obamacare and its main enrollment vehicle, HealthCare.gov, is starting to look up. Or to put it more precisely, it is no longer so crushingly negative.
After weeks of stories about website crashes and canceled health plans – and an extraordinary mea culpa from President Obama – a competing story line is starting to emerge. Slowly but surely, people are navigating the exchanges and getting insurance – for some, cheaper and better than what they had. Last week, The New York Times and Los Angeles Timestouted a “surge” in enrollment figures, especially in states that have their own exchanges.
This week, a Washington Post story described almost an Obamacare nirvana – people in rural Kentucky lining up and getting coverage, some for the first time in their lives.
Part of this wave of positive stories may be a media effect: Reporters (and the public) get tired of all the wall-to-wall negativity, and to keep interest up, seek out happy stories for a change of pace.
The Obama administration has also ramped up its public relations efforts on the Affordable Care Act (ACA), going around the national media and directly into local markets. On Tuesday, the administration
announced that seniors saved $8.9 billion on prescription drugs thanks to the ACA. And Democratic senators have headed off for Thanksgiving with marching orders: Find and publicize the ACA success stories. At the very least, say Democrats, they need to counter the Republican message machine and story-gathering.
“It’s true, the Democrats are more on the offensive than they were,” says Terry Madonna, a professor of public affairs at Franklin & Marshall College in Lancaster, Pa. “But they still have serious problems. No one knows where this is going. And for Democrats, the last thing they want is for this to dominate the elections next year.”
This Saturday, Nov. 30, will be one moment of truth. That is the day the Obama administration promised HealthCare.gov would work smoothly for the vast majority of users, after the disastrous Oct. 1 launch. The definition of “vast majority” was later downgraded to 80 percent – with the remaining 20 percent enrolling by other means or still encountering slow loads and error messages.
On Tuesday, in a conference call with state and local elected officials, Health and Human Services (HHS) Secretary Kathleen Sebelius promised a “significantly different user experience” on HealthCare.gov by the end of the month. And with reporters on the line, she urged the officials “to not hesitate to recommend that people go to HealthCare.gov and get signed up.”
Secretary Sebelius has put her credibility on the line at a time when she can ill afford to see it go any lower. The problem for the Obama administration is that by announcing a hard deadline – Nov. 30 – for vast improvements on a once-profoundly dysfunctional website, it has raised expectations (again) for how well the site will work. As with the initial rollout, Obamacare opponents will be on the lookout for failures, and the media will surely cover them.
Another moment of truth will come when the administration reveals demographic data of people who have enrolled in coverage via the exchanges, possibly with the next official enrollment numbers in mid-December. The ACA will work only if less-healthy enrollees are balanced by enrollees without expensive health issues. On Tuesday’s conference call, Sebelius said she didn’t have demographic information on enrollees, but promised it “very soon.” Then she urged the county executive from Milwaukee to reach out to “young and healthy individuals.”
The daily report Tuesday from Kaiser Health News (KHN) was noteworthy for its positive stories:
- “Health law may offer part-time workers better options,” said one headline. The story talked about “mini-med” plans – low-cost, low-benefit plans that are no longer allowable under the ACA – and cited the case of a woman with a serious health problem who is likely to get better, subsidized coverage on the exchange.
- Another piece reported on Californians happy to have their insurance policies canceled. Some people, the story reported, had felt trapped with subpar plans but had kept them because of preexisting medical conditions. Now, under the ACA, people with health problems cannot be denied coverage.
- A story out of Philadelphia, highlighted websites that have been set up that allow people to calculate their health-care subsidy without going on HealthCare.gov – and if they’re not eligible, allow them to buy coverage directly from the site.
If they are eligible, however, they have to buy their coverage on the federal exchange. So ultimately, for those living in the 36 states that are served by HealthCare.gov, all roads lead back to that site. Among the challenges ahead for the federal site:
- By Saturday, the Obama administration says HealthCare.gov should be able to handle 50,000 users simultaneously. Whether that will be enough capacity is an open question. But it’s safe to say that if too many people wait till the last minute to sign up, there could be another wave of embarrassing website failures.
- People who want their insurance to begin on Jan. 1 now have until Dec. 23 to enroll. But again, if everyone waits until Dec. 23, that leaves the insurers just eight days – right during the holidays – to process all that paperwork.
- And about that paperwork… The “834” forms that are supposed to go to the insurance companies after consumers enroll on HealthCare.gov still need work, the HHS agency in charge of the site said Monday.
- Then there’s the issue of Healthcare.gov’s “back-office system,” which a week ago was still unbuilt. On Nov. 19, Henry Chao, a top official at HHS’s Centers for Medicare and Medicaid Services (CMS), said that between 30 and 40 percent of the IT system for the marketplace remained to be constructed. That sounded alarming, but a CMS spokeswoman said that that portion of the website is involved in paying federal subsidies to insurance companies and will not affect individuals.
Getting HealthCare.gov fully functioning in time still sounds like a high-wire act. If there are more major stumbles, the bad headlines will come roaring back.