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Health Cost Burden Higher in States Without Expanded Medicaid, Study Finds

By Kerry Young, CQ Roll Call

People living in states where Medicaid has not been expanded are far more likely to still lack health insurance and face more burdensome medical bills, according to research from The Commonwealth Fund.

More than a third, or 35 percent, of adults with incomes below the poverty line remained uninsured last year in the states that had not expanded Medicaid as of mid 2014, Commonwealth researchers said in a report released last week. That was the case for only about one-fifth, or 19 percent, of people in the same economic situation in states that had expanded Medicaid. The income cutoff in this example ranged from $11,490 for an individual to $23,550 for a family of four.

"The ability of the nation to insure most of its residents will be stymied by states that do not expand their Medicaid programs," the researchers concluded.

Their report comes as Republican governors in states such as Utah and Tennessee are trying to convince GOP-controlled legislatures to expand eligibility for Medicaid. Change could come quickly in Indiana, where Republican Gov. Mike Pence may learn this month whether the Centers for Medicare and Medicaid Services will approve a plan that uses accounts similar to health savings accounts that some other states view as a template.​ At this time, there are active discussions in seven states to expand Medicaid, but no such significant movement in another 16, according to a separate Commonwealth Fund tally.

The authors of the study noted that the 2010 health law has triggered subsidies for insurance and consumer protections that have reduced the number of working-age people who lacked health coverage from about 37 million in 2010 to 29 million by the second half of 2014. The Commonwealth Fund study also found that the number of adults who reported problems paying their medical bills declined from an estimated 75 million people in 2012 to 64 million people in 2014.​

Companies involved in delivering medical care also are seeing financial benefits from the implementation of the law. R. Milton Johson, chairman and chief executive of Nashville, Tennessee-based HCA Holdings Inc., which operates hospitals and freestanding surgical centers, outlined some of the laws's benefits in a Jan. 14 presentation at JPMorgan's annual conference for medical investors. HCA has seen a 6.3 percent increase in Medicaid admissions, for example, and a decline in uninsured volumes of 9.5 percent through September 2014, he said.

"Health care reform is having a substantial impact," he said. "We're experiencing a significant improvement in our payer mix."

Johnson stressed that the Medicaid expansion in particular has had a large effect on HCA's finances. The chain operates hospitals both in states that have expanded their Medicaid program, such as California and Kentucky, and those that have not, such as Texas and Florida.  

"We have had significant growth in Medicaid admission in states that have expanded, as you would expect, and a significant 56 percent decline in uninsured admissions in those states that expanded," he said.

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