In figuring out the cost of one-third of states refusing Medicaid expansion, the real information isn't in the answers. It's in asking the right questions. This story includes no information about how much money those uninsured people will eventually cost the taxpayers under other line items -- like the programs that exist to pay for their medical bills, administered through hospitals, or the projected increase in Social Security disability claims. Nor does it address the human cost of having three million uninsured people. But as we know, we are all merely disposable digits in the grand national austerity movement! Sarah Kliff:
The Congressional Budget Office is out with its analysis of how the Supreme Court decision will impact the Affordable Care Act’s budget. The big ticket takeaway is this: The non-partisan scorekeeper estimates that 3 million people fewer people will gain coverage due to states opting out of the Medicaid expansion, resulting in $84 billion less in federal spending.
Let’s break down those numbers a bit. The Congressional Budget Office does not list out which states could pass up the Medicaid expansion. But it does predict that “some states will probably forgo the expansion entirely.”
The CBO then estimates that for every person who does not enroll in Medicaid because of that, and goes uninsured, the federal government saves $6,000 in spending by 2022. For the average person who does not enroll in Medicaid, but instead gets subsidized coverage from the health insurance exchange, the federal government spends $9,000 – $3,000 more than they would have had those individuals been in Medicaid.
“With about 6 million fewer people being covered by Medicaid but only about 3 million more people receiving subsidies through the exchanges and about 3 million more people being uninsured…the projected decrease in total federal spending on Medicaid is larger than the anticipated increase in total exchange subsidies,” the CBO concludes.
Oh, and in completely unrelated news:
States that opted for larger Medicaid programs had better health outcomes and slightly lower death rates, a study in the New England Journal of Medicine said Wednesday.
[...] The new study, by researchers at the Harvard School of Public Health, was primarily designed to look at the impact on death rates in three states that expanded Medicaid—Maine, New York and Arizona—compared with four nearby states that didn't. Overall, the study found a drop in mortality of 6.1% on average in the five years after initial expansion. Death rates fell by 19.6 deaths per 100,000 adults compared with the control states of New Hampshire, Pennsylvania, Nevada and New Mexico.
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