By Rebecca Adams, CQ HealthBeat Associate Editor
June 19, 2014 -- Medicaid and Children's Health Insurance Program enrollment will increase under the health care law by an average of 38.5 percent in seven cities where eligibility is expanding, according to a report by the Robert Wood Johnson Foundation. In seven other cities studied by the foundation where Medicaid eligibility is not changing, enrollment is projected to grow by 10.7 percent by 2016.
The report's authors modeled the impact of Medicaid expansion on the uninsured rate and federal funding in 14 cities, which are located both in states that are expanding Medicaid and are not. The cities are Atlanta; Charlotte; Chicago; Columbus, Ohio; Denver; Detroit; Houston; Indianapolis; Los Angeles; Memphis, Tenn.; Miami; Philadelphia, Phoenix, and Seattle.
Cities in states that are not expanding Medicaid would gain billions of dollars in federal revenue if the state broadened eligibility, according to the report.
If Georgia expanded Medicaid, Atlanta would see a federal spending increase from $1.9 billion to $4.8 billion. Houston would get an increase to $16.4 billion in federal spending from $9.9 billion, and Philadelphia would receive an increase from $4.5 billion to $12.6 billion, according to the report.
The Robert Wood Johnson Foundation presents generally favorable views of the health care law.
The federal government has promised to pay all of the costs for newly eligible people for the first three years and at least 90 percent of those costs later. But skeptics wonder if federal officials can carry through on that commitment.
Critics also note that states will have to pay for a growing number of Medicaid recipients that do not get the high federal matching rate as more people who qualified under the traditional guidelines, and less generous matching rates, sign up.
The report says that if Medicaid eligibility were broadened in the seven cities that are not yet expanding, the uninsured rates would fall by more than 50 percent in every city except Houston, which would see the uninsured rate fall by 44.8 percent.
Immigrants who are not in the country legally are not eligible for Medicaid, so cities such as Houston, Los Angeles, and Miami that have somewhat high populations of those residents would continue to have higher uninsured rates than other cities.
The uninsured population is expected to fall significantly in the places where eligibility for the program is broadening. The number of uninsured will drop by an average of 56.5 percent in the seven cities that will add more people to the Medicaid rolls, with decreases ranging from 48.8 percent in Denver to 65.8 percent in Detroit.
So far, 26 states and the District of Columbia have expanded eligibility under the law (PL 111-148, PL 111-152). In each of the 14 cities, at least 40 percent of the uninsured population has income under the Medicaid expansion threshold of 138 percent of the federal poverty level, according to estimates through a model used in the report.
