Kaiser Health News Original Stories

2. Political Cartoon: 'Miracle Worker?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Miracle Worker?'" by Roy Delgado.

Here's today's health policy haiku:


Ironic how fake
people got ACA plans
when real ones could not.

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Health Law Issues And Implementation

3. Budget Concerns Grow As Medicaid Enrollments Outpace Estimates In Expansion States

More than a dozen states are seeing enrollment surges well beyond expectations, and officials in some of those states are concerned about costs they will encounter in the future. Also, The Fiscal Times reports on how Medicaid coverage has developed into a dual system divided on partisan lines between states that expanded Medicaid and those that did not.

The Associated Press: Medicaid Enrollment Surges, Stirs Worry About State Budgets
More than a dozen states that opted to expand Medicaid under the Affordable Care Act have seen enrollments surge way beyond projections, raising concerns that the added costs will strain their budgets when federal aid is scaled back starting in two years. ... In Kentucky, for example, enrollments during the 2014 fiscal year were more than double the number projected, with almost 311,000 newly eligible residents signing up. That's greater than what was initially predicted through 2021. As a result, the state revised its Medicaid cost estimate from $33 million to $74 million for the 2017 fiscal year. By 2021, those costs could climb to a projected $363 million. (Cassidy, 7/19)

The Fiscal Times: The Great State Divide Over Expanded Medicaid
With Alaska Gov. Bill Walker’s decision late last week to unilaterally accept federal funds available to cover low-income people under the Affordable Care Act, three-fifths of all the states have now accepted expanded Medicaid benefits for their residents. Three years after the Supreme Court limited the expansion of Medicaid under President Obama’s health care reform law, the federal-state health program for the poor and disabled has evolved into a troubling dual system in which the availability of health care is being determined largely by the continued partisan divide over Obamacare and the geographic accident of where poor people happen to live. (Pianin, 7/19)

4. State-By-State Look At Medicaid Expansion Numbers

The Associated Press examined the success of state efforts to expand Medicaid coverage and the financial repercussions.

The Associated Press: NY Health Exchange Adds 1.1 Million To Medicaid
New York has added 1.1 million people to Medicaid since the state health exchange opened last year in the national effort to connect the uninsured with low-cost coverage. More than 6.2 million New Yorkers are now enrolled, almost one-third of its 19 million people. ... Medicaid in New York costs about $63.5 billion this year, almost half the state budget. That's up from $52.1 billion five years ago. However, the state's $22.5 billion share this year is flatter, up from $21.3 billion five years ago, according to budget officials. They cite higher federal reimbursements and frugal measures like a self-imposed spending cap and pushing patients into managed care. Enrollment is projected to rise to almost 6.5 million in 2019 at a state cost of $24.9 billion. (Virtanen, 7/19)

The Associated Press: A Look At The Numbers Around Ohio's Medicaid Expansion
Ohio is among a dozen states where enrollment has exceeded projections in the expansion of Medicaid under President Barack Obama's health care law. ... The state's share to cover those in the expanded Medicaid program in 2017 is more than twice what was projected, with officials now expecting to pay $130 million. But the Kasich administration contends the cost is more than offset by revenue generated from the Medicaid expansion population through an insurance tax and the state sales tax. It estimates that Ohio will see $301 million in tax revenue from the group in fiscal year 2017. (Sanner, 7/19)

The Associated Press: Medi-Cal Enrollment Surpasses Projections
California has enrolled 2.3 million people under an optional expansion of the state's Medicaid program -- nearly three times more than the state had anticipated, according to the state Department of Finance. ... Medi-Cal's rapid growth is now putting financial pressure on a state that was quick to embrace President Barack Obama's health care initiative. Five years ago, the program accounted for 14 percent of California's general fund. Today, Medi-Cal consumes 16 percent. In that time, the overall cost of the program has jumped to $115.4 billion from $91.5 billion, although much of the extra funding is supplied by the federal government. California officials say the decision to expand has injected billions of federal dollars into the state's economy, and they say the state is prepared to handle the additional costs through long-term budgeting and better coordination with other social programs. (Lin, 7/19)

The Associated Press: Nevada Expects To Spend More On Medicaid Than Planned
State officials say 181,051 people are now receiving benefits as a direct result of [Republican Gov. Brian Sandoval's] decision, which extends Medicaid eligibility to all non-disabled adults with incomes at or below 138 percent of the federal poverty level — currently $16,243 for an individual. That's well over the 144,340 new enrollees that state officials expected to have by this time when they were making the decision in 2012. ... The overrun means Nevada expects to spend $22.6 million in state general funds for new Medicaid enrollees in fiscal year 2017, rather than the $8.5 million it projected. (7/19)

The Associated Press: Massachusetts Predicts Net Savings For Medicaid Expansion
Many states that opted to expand Medicaid under the federal Affordable Care Act have seen enrollments surge well beyond projections .... But Massachusetts, a pioneer of health care reform, appears well situated going forward. ... In the state fiscal year that ended June 30, estimated spending for the Medicaid expansion population came to about $1.7 billion before federal matching funds. The state budget for the new fiscal year is $38.1 billion .... State health officials say that when the federal matching funds and savings from consolidating other state health coverage into Medicaid is factored in, Massachusetts will realize a net state savings for its Medicaid expansion. (7/19)

The Associated Press: Medicaid Expansion Booming In W.Va.
West Virginia has already boomed past the extra 93,000 people the state expected to enroll by 2020 under a Medicaid expansion plan ushered in by Gov. Earl Ray Tomblin in 2013. More than 164,400 people are now receiving insurance from the widely used expansion. But that won't necessarily mean the state will be footing more of the bill than it first expected. ... Even though enrollment in West Virginia exceeded projections, actual costs are expected to meet the estimates due to lower per-person costs, said Jeremiah Samples, deputy secretary of the state's Department of Health and Human Resources. An update on anticipated 2017 state costs is still in the works. (7/20)

The Associated Press: Maryland Medicaid Expansion Much Higher Than Forecast
Maryland is one of more than a dozen states where new Medicaid enrollees under President Barack Obama’s health care law have surpassed initial projects, though state analysts say Maryland is actually spending less on its Medicaid population because federal health care reform is covering 100,000 people who used to get health care paid entirely by the state. ... It’s expected that Medicaid will take up an increasingly larger percentage of the state budget moving forward. The state has found alternative revenue sources to reduce pressure on the state budget. Maryland has significantly increased provider taxes on hospital and nursing homes in recent years, and the state has continued to rely on other state funds sources to alleviate Maryland’s reliance on general funds. (Witte, 7/19)

The Associated Press: N.H. Medicaid Enrollment Surging
In New Hampshire, state officials had estimated that there would be 34,000 new enrollees in the first year. Instead, it came close to that number in the first six months, and as of June 30, there were 41,018 new enrollees, according the state Department of Health and Human Services. New Hampshire’s Gov. Maggie Hassan included $12 million for Medicaid in her state budget for fiscal years 2016 and 2017, assuming the expansion would be reauthorized once the federal government, now paying 100 percent of the costs, starts lowering its share. But after lawmakers said they would rather wait until next year to debate whether to continue the program, Hassan vetoed the Legislature’s $11.3 billion budget proposal, and the state is now operating under a six-month temporary spending plan that keeps funding at existing levels. (Ramer, 7/20)

The Associated Press: A Look At The Medicaid Expansion In New Jersey
More people have taken advantage of the expanded eligibility for Medicaid than New Jersey expected. A state-commissioned Rutgers University study had anticipated 234,000 more people on Medicaid. In May, the number of newly eligible people in the program was nearly 383,000. The state says it expects the enrollment to continue to grow and that its share of the cost next year will be $162 million. ... In the budget, the state cut charity aid to hospitals for providing care to uninsured patients to $502 million from $650 million, saying the Medicaid expansion was responsible for about half of the reduction. That cut alone would pay for most of the state’s costs next year for the expanded Medicaid program. (Mulvihill, 7/19)

The Associated Press: Oregon Underestimated Medicaid Expansion Price Tag
The Health Plan is Oregon's Medicaid program, and as hundreds of thousands of people became newly eligible last year under President Barack Obama's health care law, most of them signed up. In the first year, enrollment was 73 percent higher than anticipated, according to data from the Oregon Health Authority. ... [A] 2013 report estimated that the Medicaid expansion would cost the state $217 million in the 2017-2019 biennium, the first full two-year budget cycle in which the state begins shouldering some of the costs. The Oregon Health Authority now projects it will cost $369 million, about 70 percent more. (Cooper, 7/19)

The Associated Press: In Illinois, Medicaid Expansion Sign-Ups Double Predictions
More than twice as many Illinois residents have enrolled under the expansion than was projected by former Democratic Gov. Pat Quinn's administration. It expected 298,000 people to sign up in 2015, but 623,000 newly eligible Illinoisans enrolled by the end of June. ... In 2020, the Medicaid expansion will cost the state $208.6 million and Cook County $72.6 million, according to new projections from Gov. Bruce Rauner's administration. That year, the federal government's share of the Medicaid expansion costs will be $3.03 billion. "These impending added costs are one more reason Illinois needs to control the reckless spending of the past right now," Illinois Department of Healthcare and Family Services spokesman John Hoffman said in an emailed statement. (Johnson, 7/19)

The Associated Press: Rise In Medicaid Enrollment May Squeeze Michigan Budget
Enrollment in Michigan's expanded Medicaid program is a quarter higher today than what officials thought it would be five years from now, which will squeeze the budget starting in 2017. Gov. Rick Snyder's administration initially estimated 477,000 enrollees by 2020. But 600,000 have signed up more than 15 months after the Medicaid expansion launched. Officials expect enrollment to hover there in the future. ... The Snyder administration estimates roughly $120 million in additional budget costs over four years due to the higher-than-expected enrollment, but says insuring more people will minimize uncompensated care costs and save money across the health system. (Eggert, 7/19)

The Associated Press: Medicaid Expansion Could Save Montana $11.5 Million In First 2 Years
If implemented as soon as November, the costs of expansion in fiscal year 2016 and 2017 would be covered by the federal government. State funds would be needed for portions of the program, but they would be offset by federal dollars that are projected to save Montana about $11.5 million during that time, according to officials. ... In fiscal years 2018 and 2019, Montana would incur costs from Medicaid expansion as contributions from the federal government gradually decrease to 90 percent. Montana's cost has been projected at about $10 million in 2018, rising to about $17 million the following year. (Baumann, 7/19)