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It’s official: There are 100 million Americans on Medicaid

It’s official—Medicaid enrollment has reached 100 million individuals.

Out of those, more than 20 million are ineligible for the program. 

This is hardly a milestone worth celebrating. Having 100 million people on Medicaid means widespread dependency on government, fewer resources available for the truly needy, and crushing welfare expenditures that crowd out other budget priorities.

How we got here—the broken promises of Medicaid expansion

The Medicaid program was designed to help the truly needy—the elderly, people with disabilities, low-income children, for example. With Medicaid expansion under ObamaCare, this program was opened up to a whole new group of able-bodied adults who were previously ineligible for benefits. 

Even before the pandemic, Medicaid expansion was causing dramatic budget shortfalls and massive enrollment overruns. Nationwide, states estimated that no more than 6.5 million people would enroll in Medicaid in states that expanded. Now, enrollment in those states has surpassed that by an overrun of 160 percent.

Expansion states were enticed to expand with promises of modest increases that turned into a dramatic flood of enrollees in every single expansion state. In Idaho, for example, it was estimated that only 62,000 able-bodied adults would enroll through expansion. Now, the actual enrollment as of March 2022 is 121,219—more than double the original estimate and a 96 percent overrun. Oklahoma has seen enrollment of able-bodied adults skyrocket to more than 89 percent higher than original projections. 

Higher-than-projected enrollment means, of course, higher-than-projected costs. Nationally, per-person costs for able-bodied adults are 64 percent higher than estimated, and the story is the same in expansion states. In Arkansas, estimates placed Medicaid expansion costs at $1.8 billion over the first three years. But it has already cost Arkansas taxpayers more than $10 billion since 2018, an overrun of 67 percent. 

The real kicker: Enrollment is so much higher than projected in every state that tries expansion not because of greater need—but because Medicaid expansion shifts people from private insurance. Prior to expanding Medicaid, many people qualified for federally subsidized silver-level, private plans—expansion shifted them off private insurance and onto Medicaid.

The pandemic poured gasoline on the dumpster fire

Under the Families First Coronavirus Response Act (FFCRA), states were granted extra federal Medicaid funding only on the condition that they not remove anyone from the program—even those who became ineligible. 

Inevitably, millions more flooded into state Medicaid programs—even those programs that were already drowning because of estimate-shattering enrollment and costs.

Ninety percent of the growth of Medicaid rolls during the pandemic is attributed to ineligible people remaining in the program.

Missouri is contending with nearly half a million ineligible enrollees, costing taxpayers $400 million per month. Idaho had at least 83,000 ineligible enrollees as of January 2021. Arkansas noted more than 205,000 ineligible enrollees as of December 2022 with a price tag of nearly $22 million per month. It’s the same story in every other state that accepted the federal funding bump:

States are facing unprecedented enrollment and staggering costs thanks to these “Medicaid handcuffs”—but as long as they receive the federal funding bump, they can do nothing about it.

The result? Waitlists, hospital closures, job losses, and more

Medicaid, a program initially intended for vulnerable populations, is on the verge of imploding nationwide because of expansion coupled with the handcuffs. And the consequences are real and profound.

  • Medicaid expansion proponents promised a boon to hospitals, but expansion is a death knell for hospitals. Because Medicaid reimburses providers at roughly 60 percent of what private insurance reimburses, expansion states lose money from the influx of patients shifted from private insurance to Medicaid. 
  • Between 2013 and 2026, Medicaid shortfalls in hospitals in expansion states grew by roughly 50 percent—far outpacing revenue growth. 
  • Since 2014, nearly 50 hospitals have closed in expansion states—with several of these closures a direct result of Medicaid expansion. 

Even more distressing is that as states spend more on Medicaid, there is less space in the budget for other priorities. High Medicaid expenditures end up crowding out other line items like public safety and education. And with thousands of able-bodied, ineligible people added to Medicaid, there are even fewer resources available for the truly needy—and waiting lists become even longer.

100 million enrollees. Now what?

Despite the Biden administration extending the public health emergency into May, Congress stepped in to allow states to begin conducting eligibility redeterminations on April 1, 2023. In other words, states will be able to finally remove ineligible individuals from the program. This is simply a return to normal—not a program cut. This step will reinstate eligibility parameters that had previously been in place and followed until the pandemic. 

Not only is keeping ineligible individuals on Medicaid expensive (costing taxpayers nearly $16 billion per month!) but most concerning is how it also is leaving less for those truly in need. 

The Medicaid handcuffs are unlocked. We’ve hit a rock-bottom milestone with nearly one-third of Americans on Medicaid. Now, states must expedite the redetermination process.  




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