A notable new publication was released Aug. 25 about the financial effect of the decision not to expand Medicaid on all those who purchase health insurance in the marketplace. Authors Aditi P. Sen and Thomas DeLeire analyzed data on cost in adjacent areas with and without Medicaid expansion.
The data support that those who are purchasing insurance in the marketplace in non-Medicaid expansion states, like ours, pay 7 percent more per person for coverage. This may not sound like a lot, but if you are living on 140 percent of the Federal Poverty Level (FPL), which is $22,428 annually for a couple, any additional amount is a burden. Since the average Silver Plan is $328 per month, the two would pay an additional $46 per month.
The reason for this is that in states which did not expand Medicaid, 40 percent of marketplace purchases are made by (or by someone else on their behalf) people between 100 percent and 138 percent of the FPL. There is evidence that those individuals suffer more health problems and heavily negatively influence the insurance risk pool, so the companies charge everyone in the pool more. In states in which Medicaid was expanded, only 6 percent of the pool is comprised of this income level, and the pool is healthier and wealthier.
As hospitals and communities decide to buy coverage for individuals with low incomes to keep them from being uninsured, we must consider the detrimental effect on other people who are buying their own plans. We all pay, one way or another, when large segments of the community are uninsured. Expansion of Medicaid is a low-cost option which must be explored here.
Linda Mewis Christmann, MD, MBA