By Sean Miskell
On the eve of a midterm election that has seen state policy makers reconsidering their opposition to Medicaid expansion, an analysis conducted by the New York Times finds that 3 million more would gain coverage if all states expanded Medicaid. This finding highlights the importance role that state policy makers can play in providing their residents with coverage and reducing disparities between states.
Writing for the New York Times’ blog The Upshot, Kevin Quealy and Margaret Sanger-Katz use data from Enroll America and Civis which is “based on interviews with thousands of adults along with commercial and government data” and is intended to capture who has insurance now compared with 2013. But analyzing the data under the assumption that all states have expanded Medicaid portrays a scenario in which 3 million more have coverage and the uninsured rate is two percentage points lower.
But in addition to increasing the ranks of the insured nationwide, the Upshot’s analysis also highlights how disparities between states would decrease if all states embraced Medicaid expansion. The Upshot breaks down the data by county, and highlights how residents in neighboring states – such as Kentucky/Tennessee, New Hampshire/Vermont – have fared very differently depending on whether their state leaders have chosen to expand Medicaid. The disparities in coverage are regional as well. As we have pointed to before, the Upshot’s analysis highlights that residents of southern states are particularly hurt by their representatives’ failure to accept federal funding to expand Medicaid.
While the Upshot’s finding that three million more would gain coverage if all states expanded Medicaid, Say Ahhh! Readers know that Medicaid expansion’s benefits start with coverage for individuals and families and ripple outwards. In states that expand, hospitals provide less uncompensated care. While Medicaid spending has increased across the country, spending has increased more slowly in expansion states, helping these states that have embraced expansion to cover more of their residents for less money compared to states whose leaders have refused to expand Medicaid.
The Upshot frames its helpful analysis in the context of what might happen if the Supreme Court had not made Medicaid expansion optional in 2012. But the disparities that the study highlights are the result of decisions made by state-level policy makers. These policy makers cannot control the decisions of the high court, but they can control whether their residents have access to the Affordable Care Act’s Medicaid expansion.
