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Fact check/Did 14.5 million gain health insurance through Medicaid expansion?

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Fact check: Did 14.5 million gain health insurance through Medicaid expansion?

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March 24, 2017
By Cory Eucalitto

NPR's Morning Edition interviewed Rep. Buddy Carter (R-Ga.) on the proposed American Health Care Act, a bill to repeal and replace parts of the Affordable Care Act. Discussing the potential impact on Medicaid of the proposed reforms, Rep. Carter said, "If you look at the 20 million who have gained insurance as a result of Obamacare, 14 and a half million of those have come through Medicaid expansion."[1]

Is Rep. Carter correct that 14.5 million people gained health insurance under Obamacare as a result of the expansion of Medicaid eligibility? Not quite.

According to the most recent government data, an estimated 11.2 million adults were enrolled in Medicaid as of 2016 based on the eligibility expansion instituted by the Affordable Care Act.[2]

Background

Rep. Earl "Buddy" Carter represents Georgia's 1st Congressional District, which includes Savannah.

As introduced, the American Health Care Act would eliminate the ACA’s mandate that individuals obtain health insurance or pay a fine. Instead, the bill would require insurers to apply a 30 percent premium surcharge to individuals who go without healthcare coverage for more than 63 continuous days in a year. It would also eliminate the income-based tax credits and subsidies provided by the ACA, swapping those for age-based refundable tax credits of $2,000 to $4,000 annually, which would progressively phase out based on income for individuals earning more than $75,000 (or $150,000 for joint filers). It would authorize $100 billion in federal funding to establish state-run coverage for high-risk individuals with pre-existing conditions, provided that states match a certain percent of their federal receipts starting at 7 percent in 2020 and reaching 50 percent by 2026.[3][4]

Rep. Carter supports the AHCA.[1]

Medicaid expansion

The Affordable Care Act of 2010 increased the number of Americans with healthcare coverage in two ways: by subsidizing the purchase of insurance on government exchanges and by directing states to expand Medicaid eligibility to individuals with household incomes up to 138 percent of the federal poverty level (up from 100 percent).[5] Originally, the law called for withholding the entire federal share of Medicaid payments from states that refused to expand eligibility. However, on June 28, 2012, the U.S. Supreme Court ruled that threatening to withhold the entire federal share of Medicaid from states that did not expand Medicaid was unconstitutionally coercive.[6] (The ACA also shifted coverage of children in families with incomes between 100 and 138 percent of the poverty line from the Children’s Health Insurance Program to Medicaid.)[7]

A total of 31 states and the District of Columbia expanded Medicaid eligibility.[8]

Total federal expenditures for adults who became eligible for Medicaid under the expansion criteria were $23.9 billion in 2014 and $58.1 billion in 2015. The government projects that the federal cost will be $741 billion from 2016-2025.[2]

The pending bill would codify the Supreme Court ruling that Medicaid expansion is voluntary for states. Starting in 2020, the legislation would reduce federal funding for expansion-eligible adults from 90 percent of costs to the standard cost-sharing formula in each state (which averages a federal share of 57 percent). States would only receive that federal match for expansion-eligible adults if they were enrolled on or before December 31, 2019, and had no more than one month's break in coverage.[4][3]

The Claim

Rep. Carter's claim has two parts:

  1. 20 million Americans gained health insurance as a result of the ACA, and
  2. 14.5 million of those Americans gained healthcare coverage under the Medicaid expansion criteria.[9]

The 20 million figure was reported by the Department of Health and Human Services (HHS), which estimated that "20.0 million uninsured adults have gained health insurance coverage because of the Affordable Care Act as of early 2016."[10]

However, the 20 million figure does not represent the number of distinct individuals who gained coverage through government exchanges and Medicaid. Instead, it reflects the net change in healthcare coverage between 2010 and 2016, accounting for both dropouts and re-enrollees.[10]

Secondly, Carter was incorrect in claiming that 14.5 million people enrolled in Medicaid under the ACA’s expansion criteria. According to HHS, the 14.5 million figure is the total new enrollment for Medicaid (and CHIP) in states offering both conventional and expansion eligibility in 2014 and 2015.[10][8][11] (The total for those years was later revised to 15.3 million, and the estimate through 2016 was 16.2 million.)[12][13]

As of 2016, a total of 11.2 million adults were enrolled in Medicaid under the expansion criteria (incomes between 100 percent and 138 percent of the federal poverty level). That number is projected to rise to 13.2 million by 2025.[2]

Conclusion

On NPR, Rep. Buddy Carter (R-Ga.) claimed that “[of] the 20 million who have gained insurance as a result of Obamacare, 14 and a half million of those have come through Medicaid expansion."[1]

Rep. Carter is incorrect, and his mistake is a common one.

HHS has estimated that 20 million adults, on net, gained healthcare coverage under the ACA as of early 2016. That figure does not represent the number of distinct individuals who gained coverage through government exchanges and Medicaid expansion. Instead, it reflects the net changes in coverage between 2010 and 2016, accounting for both dropouts and re-enrollees.[10]

As for Medicaid enrollment, HHS estimates that 11.2 million adults (not 14.5 million as Carter claimed) were enrolled in Medicaid under the expansion criteria as of 2016.[2]


See also

Sources and Notes

  1. ↑ 1.0 1.1 1.2 NPR, "Rep. Buddy Carter On The Republican Health Care Plan," March 8, 2017
  2. ↑ 2.0 2.1 2.2 2.3 Medicaid.gov, "2016 Actuarial Report on the Financial Outlook for Medicaid," accessed March 22, 2017
  3. ↑ 3.0 3.1 U.S. Government Publishing Office, "115th Congress, 1st Session, H.R. 1628," accessed March 22, 2017
  4. ↑ 4.0 4.1 Congressional Budget Office, "Congressional Budget Office Cost Estimate, American Health Care Act," March 13, 2017
  5. ↑ 138 percent of the federal poverty level is equal to $16,643 for individuals and $33,948 for a family of four. An individual is eligible with income at this level if their state has expanded Medicaid. Healthcare.gov, "Federal Poverty Level (FPL)," accessed March 24, 2017
  6. ↑ SCOTUSblog, "Court holds that states have choice whether to join medicaid expansion," June 28, 2012
  7. ↑ Medicaid.gov, "Affordable Care Act, CHIP," accessed March 20, 2017
  8. ↑ 8.0 8.1 The Henry J. Kaiser Family Foundation, "Status of State Action on the Medicaid Expansion Decision," accessed March 20, 2017
  9. ↑ Rep. Carter's office confirmed for Ballotpedia that his source on Medicaid enrollment was CMS, a branch within HHS. Cory Eucalitto, “Email communication with Mary Carpenter,” March 8, 2017
  10. ↑ 10.0 10.1 10.2 10.3 Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, “Health Insurance Coverage and the Affordable Care Act, 2010-2016,” March 3, 2016
  11. ↑ Expanded eligibility began on January 1, 2014, in 24 states plus D.C. Expanded eligibility began at a later date in Michigan (4/1/2014), New Hampshire (8/15/2014), Pennsylvania (1/1/2015), Indiana (2/1/2015), Alaska (9/1/2015), Montana (1/1/2016), and Louisiana (7/1/2016).
  12. ↑ Enrollment increase estimates do not include Connecticut or Maine. Medicaid.gov, "UPDATED: Medicaid & CHIP December 2015 Application, Eligibility, and Enrollment Data (pdf)," February 2016
  13. ↑ Enrollment increase estimates do not include Connecticut or Maine. Medicaid.gov, "PRELIMINARY: Medicaid & CHIP December 2016 Application, Eligibility, and Enrollment Data," accessed March 20, 2017
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