Note: This article is part of Mississippi Today’s ongoing Mississippi Health Care Crisis project. Learn more about the project by clicking here.
Perhaps no other federal state policy has been studied and debated more than the expansion of Medicaid under the federal Affordable Care Act, including its potential impact on Mississippi – one of 12 states have not expanded the program.
A Kaiser Family Foundation report notes that there have been more than 400 studies on the topic nationwide. And in Mississippi, the poorest and most unhealthy state in the nation, many studies have focused on what expansion would mean. A majority project has positive net benefits in economics, health, or both.
READ MORE: What is Medicaid expansion, really? Answers to common questions.
The expansion would mean that someone earning $18,754 a year (138% of the poverty line) would be eligible for health care coverage through the federal state program. The federal government would pay 90% of the costs for those covered, with the state paying 10%.
When the Medicaid expansion began on January 1, 2014, the federal government paid 100% of the costs, reduced to 90% over the years. Mississippi missed out on the federal government’s higher matching rates.
But under the recent US bailout, the 12 states that did not expand Medicaid were offered a financial incentive to do so. This equates to more than $700 million for Mississippi, and more recent studies have taken these incentives into account.
Studies of Medicaid expansion in Mississippi
• University of Mississippi/DIH Research Center, 2021: This analysis of the fiscal and economic impact of the expansion was authored by State Economist Corey Miller and Senior Economist Sondra Collins. It found that the expansion would add about 230,000 adults to Mississippi’s Medicaid rolls between 2022 and 2027. It would create an average of 11,000 new jobs per year during that time and provide an additional $44 million per year to the general fund of the ‘State.
The study found that the expansion would increase the state’s gross domestic product by more than $700 million per year over five years, increase personal income between $539 million and $812 over the same period, and would increase the state’s population between 3,300 and 11,500 per year over the same period.
• Commonwealth Fund Study, 2021: The study estimates the expansion would cost the state $956 million over five years, while generating $1.2 billion in savings for a net gain to state coffers of $212 million. The study estimates that the expansion would provide coverage for around 230,000 adults.
• Urban Institute/Robert Wood Johnson Foundation National Study, 2020: This was a study of the impact of the expansion on the 15 states at the time that had not expanded Medicaid. The study predicted that expansion in Mississippi would result in an increase of 207,000 enrollees and an increase in state Medicaid costs of $177 million per year, but did not attempt to calculate an increase in revenue or costs. savings.
• Perryman Group study of the Mississippi Cares Plan, 2019: This was a study of the Mississippi Hospital Association’s “Mississippi Cares” alternative expansion plan. The MHA has proposed creating a public-private partnership, expanding eligibility to adults earning up to 138% of the poverty line, but imposing a $20 per month premium on enrollees and a $100 copay for l non-emergency use of hospital emergency rooms. Hospitals would cover the remaining state costs. The Perryman study projected that the plan would create an additional 36,000 jobs per year on average for the first 11 years and provide increased state tax revenue, lower private insurance premiums, and lower health care costs. uncompensated care of $252 million per year. The plan also included an obligation for unemployed beneficiaries to enroll in vocational training or education programmes.
• University of Alabama at Birmingham study for the Mississippi Health Advocacy Program, 2013: This study, conducted by UAB’s Department of Health Care Organization and Policy, modeled the impact of the expansion on enrollment, state and federal costs, employment and tax revenue. from 2014 to 2020. It projected that the expansion would result in 212,362 additional enrollments by 2020, generate 19,318 additional jobs in 2020, along with $200 million in additional state and local tax revenue. It predicted overall state budget savings of $34 million in 2020, and the projected expansion would generate $2 billion in economic activity annually.
• Kaiser Foundation/Urban Institute National Study, 2012: This study projected the effect of expansion on costs and enrollments nationally and by state from 2013 to 2022. The study projected that expansion in Mississippi would cost the state approximately $1 billion for the period and would result in 231,000 additional registrants. The study listed additional costs without estimating savings or increases in tax revenue.
• University of Mississippi/DIH Research Center, 2012: This study projected the impact of expansion on Medicaid costs, enrollments, and net economic impact on the state budget from 2014 to 2025. The study used three scenarios, high, medium, and low, predicting that a high turnout of 310,000 additional registrants was most likely. He predicted the cost of expanding the state would be about $118 million by 2020, but the expansion would create about 9,000 new jobs a year and have a net positive impact on the state budget. close to $65 million by 2020.
• Milliman Inc. study, 2010, 2012: The Mississippi Division of Medicaid contracted this analysis from Mississippi Medicaid’s budget exposure to the 2011-2020 ACA, and it was updated in 2012 and is still frequently referred to by opponents of the expansion. The report modeled three scenarios – low, moderate and high enrollment increases and said moderate or low scenarios were the most likely. The report projected in the moderate scenario that 243,000 more adults and 67,000 more children would enroll and that the state’s share of Medicaid costs would increase by $1.26 billion over the period, including costs for current and additional registrants. He estimated that by fiscal year 2020, the state would see an increase in costs of $280 million per year.
The 2012 report modeled enrollments and costs for the 2014-2020 fiscal year under various scenarios. Under the higher enrollment scenario, he estimated that the expansion would cost the state $155 million per year by 2020. He focused on the Medicaid budget and estimated no compensation for costs from other programs or additional tax revenue.
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