Medicaid Expansion: We Already Know How the Story Ends

Other states’ experiences with expanding Medicaid reveal the likely impact on Florida

EXECUTIVE SUMMARY

Supporters of the Affordable Care Act’s optional Medicaid expansion have made a series of promises to Florida lawmakers as they decide if the government health program should include parents and childless adults earning up to 138 percent of the federal poverty level. These promises include a reduction in the rate of uninsured, gradual enrollment increases, low and predictable costs, and a reduction in the amount of charity care.

These same promises were made in other states that previously expanded their own Medicaid programs. Because of this, Florida lawmakers now have an opportunity to see how Medicaid expansion impacted those states, and if supporters’ promises were actually kept.

This report takes a closer look at Arizona, Maine and other states that expanded Medicaid. It finds that, unfortunately, expansion supporters have a poor track record of keeping promises.

• Enrollment among the expansion populations was much higher and faster than the slow and gradual enrollment that was projected.
• Medicaid expansion had little impact on the rate of uninsured. Arizona’s uninsured rate actually increased in the five years after expansion, while Maine’s did not change.
• Per-person costs for the new expansion populations were much higher than projected—particularly for the childless adult populations.

The experiences of these other states are instructive for Florida lawmakers. In those states, promises made by supporters of Medicaid expansion were unable to be kept. The same will likely be true for Florida if lawmakers ultimately decide to expand.

Florida lawmakers are faced with a choice. The federal Affordable Care Act (ACA) urges states to expand their Medicaid programs for those earning up to 138 percent of the federal poverty level. However, a recent decision by the U.S. Supreme Court makes the expansion voluntary for Florida, and all states.

Fortunately, Florida has the benefit of reviewing the experiences of other states that have already expanded Medicaid eligibility to a similar population. Before making any decision, state lawmakers should carefully review these experiences to better understand how the optional expansion could affect Florida.