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The Agenda

NRO’s domestic-policy blog, by Reihan Salam.

Today’s Policy Agenda: Medicaid Is Expanding, Even in States That Didn’t Expand Medicaid



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Medicaid is expanding, even in states that didn’t expand Medicaid.

At the Upshot, Margot Sanger-Katz reports that nearly 1 million residents of states not expanding Medicaid under the ACA have signed up for Medicaid this year (versus the sign-up rates that would be expected):

Medicaid enrollment has also increased this year in many states that chose not to accept federal funds. Data from Medicaid released Friday show that enrollment jumped in most states that did not expand their programs, including Georgia (16 percent), Montana (10 percent), Idaho (9 percent) and Florida (7 percent). Altogether, enrollment in Medicaid and the Children’s Health Insurance Program in the states that didn’t make any changes has gone up by 975,000.

Nearly all states that didn’t expand had some increase in Medicaid enrollment, and a few state’s programs grew significantly. Georgia and Montana both saw double-digit increases, with their enrollments increased by 16 percent and 10 percent, respectively.

This phenomenon is something policy makers call the woodwork effect, which is when people who were previously eligible finally decide to sign up. In this case, the campaigns to encourage people to enroll in Medicaid in expansion states and to enroll in exchange plans have likely raised awareness about Medicaid and caused people to seek benefits.

These new enrollees are present a financial concern for both opt-out and opt-in states. Even states that expanded Medicaid have had a wave of previously eligible people sign up, and states have to pay the same share of the expenses for already-eligible beneficiaries as they did before the expansion (around 40 percent of the cost, while the feds cover about 60 percent, generally, but it varies by state). In addition, states have to cover the administrative costs for all Medicaid enrollees, whether they’re eligible because of the ACA or not.

Jobs are being created, but the new jobs pay less than the ones that were created before the recession.

In Bloomberg Businessweek, Peter Coy discusses a document released Monday by the United State Conference of Mayors, which reported that the average job created during the recent recovery pays 23 percent less annually. 

From early 2010 through mid-2014, while the economy gained a little more than 9 million jobs, the fastest growth came in the low-paying accommodation and food sector; this year the average annual wages in the sector are just under $21,000. Only the fifth-fastest-growing sector since 2010 has been a high payer: professional, scientific, and technical employment, with average annual wages in today’s dollars of about $87,000. For job-gaining sectors as a whole, the weighted average of pay has been just $47,171 a year.

Nearly half of the jobs lost in the 2008 recession were in manufacturing or construction, which are relatively high-paying sectors. Conversely, the most growth during the recovery has come from lower-paying sectors like the food and accommodation industries. Of course, average wages have risen during the recovery, but slowly.

HHS is threatening to cut off Obamacare for thousands of people who haven’t verified their citizenship or immigration status.

In Vox, Sarah Kliff reports that CMS sent final notices requesting proof of legal residence to 310,000 individuals this week. If they do not provide proof of citizenship or legal immigration status by September 5, they will lose their health care coverage on September 30. This map shows the share of letters going to each state:

Floridians and Texans will receive the largest amount of letters, with each state receiving nearly 94,000 and 53,0000 respectively.

According to CMS, there were nearly 1 million cases of problematic immigration status for enrollees in May, and about half of them have been resolved; an additional 210,000 are in the process of being resolved.

Not one person has lost coverage because of his or her immigration status so far, Kliff notes.



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