Medicaid Expansion Is a Bad Deal for States, Providers, and Those It Claims to Help

Overview

The Medicaid program was designed to provide a safety net for children, individuals with disabilities, pregnant women, and other truly needy groups.¹ But the Affordable Care Act, commonly known as ObamaCare, allowed states to expand Medicaid beyond its original purpose to include a new class of able-bodied adults.²

Nearly three times as many able-bodied adults have signed up for ObamaCare expansion as states initially predicted.³ By 2023, expansion enrollment had reached a whopping 19 million.⁴ Total program enrollment topped 100 million in 2023, and current enrollment remains far above pre-pandemic levels. ObamaCare expansion has driven most of this growth.^6-8

Surging enrollment has led to skyrocketing spending. In 2013, taxpayers spent $406 billion on the Medicaid program.⁹ A decade later, total Medicaid spending has more than doubled, reaching nearly $874 billion.¹⁰ Medicaid now consumes nearly one-third of states’ non-capital budgets and is growing nearly twice as fast as state tax revenues.^11-13 Expanding Medicaid in non-expansion states would burst already tight budgets and kick millions off of private insurance.¹⁴

Those crowded out by Medicaid expansion already have access to zero-cost health insurance

If the remaining states were to expand Medicaid, more than 5.8 million Americans who currently have private insurance and earn between 100 and 138 percent of the federal poverty level (FPL) would be forced onto Medicaid.¹⁵ These individuals already have access to health insurance through the exchange—with taxpayers paying the entirety of their premiums—and would lose this coverage if their state expanded Medicaid.

In states that have not expanded Medicaid, federal premium subsidies are available for those with earnings above the federal poverty level.¹⁶ However, when a state expands Medicaid coverage, those who earn between 100 and 138 percent of the federal poverty level are no longer able to receive subsidies and are shifted onto Medicaid instead.¹⁷

An analysis of health plans in non-expansion states shows that 98 percent of individuals who earn between 100 and 138 percent of the federal poverty level have access to health plans through the exchange with no out-of-pocket premium and no deductible.^18-44 More than 94 percent have access to plans with fully subsidized premiums, no deductibles, and no copays for primary care visits or generic prescription drugs.⁴⁵

Overall, 98 percent of individuals who would be forced onto Medicaid by expansion can obtain a benchmark plan with no deductible.⁴⁶ For those who live in counties where the benchmark plans do have deductibles, no-deductible plans are available for a premium that averages just $0.58 to $2.10 per month out of pocket, depending on the age of the individual.⁴⁷ The majority of these plans also have no copays for generic prescriptions or primary care visits.⁴⁸ Able-bodied, childless adults in non-expansion states can access these subsidized health plans by working roughly 21 hours per week at the average entry-level wage in their states.⁴⁹

When individuals are kicked off private insurance and forced onto Medicaid, they may lose access to their doctors. Nationally, 96 percent of providers accept new patients with private insurance.⁵⁰  By comparison, only 74 percent of providers accept Medicaid patients.⁵¹ In certain specialties, the gap between private insurance and Medicaid acceptance is even greater, especially in states that have expanded.⁵²

Shifting able-bodied adults from private insurance to Medicaid is devastating to providers and siphons resources from the truly needy

Medicaid pays providers for services at a much lower rate than private insurance.⁵³ In addition to providers declining to accept Medicaid patients due to this gap in reimbursement rates, hospitals face significant declines in revenue when Medicaid enrollment increases.⁵⁴ If the 5.8 million people currently enrolled in private insurance in non-expansion states are forced onto Medicaid by expansion, hospitals in these states would stand to lose more than $8 billion in revenue as a result.⁵⁵

In states that have expanded Medicaid, hospital Medicaid shortfalls—the gap between how much services cost to provide and reimbursements from Medicaid—have surged.⁵⁶ Since 2013, hospital shortfalls in expansion states have increased by 117 percent.⁵⁷

Hospitals rely on private insurance payments to cover the Medicaid shortfalls, so when millions are moved from private insurance to Medicaid, hospitals pay the price.⁵⁸ In states that have expanded Medicaid, costs to provide services have ballooned while revenues decline.⁵⁹ If the remaining states expand Medicaid, hospitals in these states would face more than $13.2 billion in total Medicaid shortfalls.⁶⁰

Forcing privately insured patients onto Medicaid is especially devastating to rural hospitals because there are fewer patients to balance out the shortfalls.⁶¹ Nationwide, 30 percent of rural hospitals are at risk for closure due to losses.⁶² When hospitals shut down, access to health care for the entire community is imperiled and there are worse health outcomes for everyone.⁶³

Worse yet, moving people from private insurance to welfare takes resources from the truly needy. Nearly 700,000 Medicaid enrollees are on waiting lists for services already.⁶⁴ Adding millions to the Medicaid rolls will only exacerbate this problem.

The Bottom Line: Ninety-eight percent of low-income adults have access to health plans with no out-of-pocket premium and no deductible. Expanding Medicaid to include able-bodied adults would harm the truly needy and explode state budgets.

Medicaid expansion has not been the silver bullet that advocates promised. Expansion states have seen surging enrollment, ballooning costs, and plunging revenue for providers. In non-expansion states, virtually all low-income, able-bodied adults already have access to health plans with fully subsidized premiums, no deductibles, and no copays. Kicking these individuals off their private insurance would harm the truly needy, hamper economic growth, and lead to catastrophic loss of revenue for hospitals. States that have expanded Medicaid should roll it back, and the remaining states should continue to reject expansion, preserving resources for the truly needy.

REFERENCES

1. Jonathan Bain, “Busted budgets and skyrocketing enrollment: Why states should reject the false promises of Medicaid expansion,” Foundation for Government Accountability (2023), https://thefga.org/research/states-should-reject-false-promises-of-medicaid-expansion.
2. Ibid.
3. Ibid.
4. Jonathan Bain, “How millions of Americans will be kicked off private insurance if the remaining states expand Medicaid,” Foundation for Government Accountability (2024), https://thefga.org/research/how-millions-americans-kicked-off-private-insurance.
5. Centers for Medicare and Medicaid Services, “Medicaid enrollment: New adult group,” U.S. Department of Health and Human Services (2024), https://data.medicaid.gov/dataset/6c114b2c-cb83-559b-832f-4d8b06d6c1b9.
6. In fiscal year 2013, roughly 59.8 million people were enrolled in Medicaid. By fiscal year 2023, enrollment had grown to nearly 98 million, with more than 19.4 million of those enrollees newly eligible under ObamaCare.
7. Centers for Medicare and Medicaid Services, “2018 actuarial report on the financial outlook for Medicaid,” U.S. Department of Health and Human Services (2020), https://www.cms.gov/files/document/2018-report.pdf.
8. Centers for Medicare and Medicaid Services, “Medicaid enrollment: New adult group,” U.S. Department of Health and Human Services (2024), https://data.medicaid.gov/dataset/6c114b2c-cb83-559b-832f-4d8b06d6c1b9.
9. Authors’ calculations based upon data provided by the National Association of State Budget Officers on total Medicaid expenditures between fiscal years 2013 and 2023. See, e.g., National Association of State Budget Officers, “1991-2023 state expenditure report data,” National Association of State Budget Officers (2023), https://www.nasbo.org/reports-data/historical-data.
10. Ibid.
11. Authors’ calculations based upon data provided by the National Association of State Budget Officers on total Medicaid expenditures between fiscal years 2013 and 2023 and data provided by the U.S. Department of Commerce on total state tax revenues between fiscal year 2013 and 2023.
12. National Association of State Budget Officers, “1991-2023 state expenditure report data,” National Association of State Budget Officers (2023), https://www.nasbo.org/reports-data/historical-data.
13. Census Bureau, “Annual survey of state government tax collections data: Historical dataset,” U.S. Department of Commerce (2024), https://www2.census.gov/programs-surveys/stc/datasets/historical/STC-Historical-DB.xlsx.
14. Jonathan Bain, “How millions of Americans will be kicked off private insurance if the remaining states expand Medicaid,” Foundation for Government Accountability (2024), https://thefga.org/research/how-millions-americans-kicked-off-private-insurance.
15. Authors’ calculations based on Exchange enrollment during the 2024 open enrollment period, disaggregated by state and income level. See, e.g., Centers for Medicare and Medicaid Services, “2024 open enrollment period state-level public use file,” U.S. Department of Health and Human Services (2024), https://www.cms.gov/files/zip/2024-oep-state-level-public-use-file.zip.
16. Jonathan Bain, “How millions of Americans will be kicked off private insurance if the remaining states expand Medicaid,” Foundation for Government Accountability (2024), https://thefga.org/research/how-millions-americans-kicked-off-private-insurance.
17. Ibid.
18. Authors’ calculations based upon data provided by the U.S. Department of Health and Human Services on every lowest-cost and benchmark silver plan offered in every rating area in every non-expansion state.
19. In Alabama, UnitedHealthcare offers plan number 69461AL0110014 at or below the benchmark plan premium in rating area 1, rating area 3, rating area 5, rating area 6, rating area 7, rating area 9, rating area 12, and rating area 13. Ambetter of Alabama offers plan number 53932AL0100012 at or below the benchmark plan premium in rating area 2, rating area 4, rating area 8, rating area 10, and rating area 11. Blue Cross and Blue Shield of Alabama offers plan number 46944AL0730001 at or below the benchmark plan premium in rating area 8. These plans have no deductibles and no copays for primary care visits or generic prescription drugs.
20. In Florida, Ambetter from Sunshine Health offers plan number 21663FL0130127 at or below the benchmark plan premium in rating area 1, rating area 2, rating area 3, rating area 4, rating area 5, rating area 7, rating area 9, rating area 12, rating area 14, rating area 15, rating area 18, rating area 19, rating area 20, rating area 22, rating area 23, rating area 27, rating area 28, rating area 29, rating area 30, rating area 31, rating area 32, rating area 33, rating area 34, rating area 36, rating area 37, rating area 38, rating area 39, rating area 40, rating area 41, rating area 45, rating area 46, rating area 47, rating area 48, rating area 49, rating area 52, rating area 53, rating area 54, rating area 56, rating area 58, rating area 60, rating area 61, rating area 65, rating area 66, and rating area 67. Aetna CVS Health offers plan number 18628FL0160029 at or below the benchmark plan premium in rating area 6, rating area 11, and rating area 64, plan number 18628FL0160009 and plan number 18628FL0160029 at or below the benchmark plan premium in rating area 8, rating area 13, rating area 24, rating area 26, rating area 51, and rating area 59. Molina Healthcare offers plan number 54172FL0010002 at or below the benchmark plan premium in rating area 10. UnitedHealthcare offers plan number 68398FL0030040 at or below the benchmark plan premium in rating area 16, rating area 21, rating area 25, rating area 35, and rating area 55. Cigna Healthcare offers plan number 48121FL0070030 at or below the benchmark plan premium in rating area 42. AmeriHealth Caritas Next offers plan number 67926FL0010003 at or below the benchmark plan premium in rating area 43. Florida Blue offers plan number 16842FL0120072 and plan number 16842FL0120094 at or below the benchmark plan premium in rating area 44 and plan number 30252FL0070035 at or below the benchmark plan premium in rating area 62. Oscar Insurance Company of Florida offers plan number 40572FL0200025 at or below the benchmark plan premium in rating area 50. These plans have no deductibles and no copays for primary care visits or generic prescription drugs.
21. In Florida rating area 17, Health First Commercial Plans offers plan number 36194FL0440002 and Oscar Insurance Company of Florida offers plan number 40572FL0070025 at or below the benchmark plan premium. These plans have no deductibles, but plan number 36194FL0440002 has a $10 copay for primary care visits and a $5 copay for generic prescription drugs, while plan number 40572FL0070025 has a $5 copay for primary care visits and no copays for generic prescription drugs. While rating area 17 has no plans offered at or below the benchmark premium with no deductible and no copays for primary care visits and generic prescription drugs, Oscar Insurance Company of Florida also offers plan number 40572FL0070025, which has no deductible and no copays for primary care visits and generic prescription drugs. The premium for this plan ranges from $0.64 more per month than the benchmark plan premium to $2.55 more per month, depending on the enrollee’s age.
22. In Florida rating area 57, Health First Commercial Plans offers plan number 36194FL0440002. This plan has no deductibles but has a $10 copay for primary care visits and a $5 copay for generic prescription drugs. While rating area 57 has no plans offered at or below the benchmark premium with no deductible and no copays for primary care visits and generic prescription drugs, Molina Healthcare offers plan number 54172FL0010002, which has no deductible and no copays for primary care visits and generic prescription drugs. The premium for this plan ranges from $1.23 more per month than the benchmark plan premium to $4.83 more per month, depending on the enrollee’s age.
23. In Florida rating area 63, Florida Blue offers plan number 30252FL0070076 and plan number 30252FL0130005 at or below the benchmark plan premium. These plans have a $100 deductible and no copays for primary care visits or generic prescription drugs. While rating area 63 has no plans offered at or below the benchmark premium with no deductible and no copays for primary care visits and generic prescription drugs, Florida Blue offers plan number 30252FL0070035, which has no deductible and no copays for primary care visits and generic prescription drugs. The premium for this plan ranges from $0.01 more per month than the benchmark plan premium to $0.03 more per month, depending on the enrollee’s age.
24. In Georgia, Aetna CVS Health offers plan number 82824GA0110013 and plan number 82824GA0110025 at or below the benchmark plan premium in rating area 1 and rating area 2. Oscar Health Plan of Georgia offers plan number 58081GA0010052 at or below the benchmark plan premium in rating area 3, rating area 4, and rating area 13. Ambetter from Peach State Health Plan offers plan number 70893GA0010077 at or below the benchmark plan premium in rating area 5, rating area 7, rating area 8, rating area 9, rating area 10, rating area 12, rating area 15, and rating area 16. Anthem Blue Cross and Blue Shield offers plan number 45334GA0010112 at or below the benchmark plan premium in rating area 6 and rating area 11. Ambetter from Peach State Health Plan offers plan number 70893GA0090007 at or below the benchmark plan premium in rating area 14. These plans have no deductibles and no copays for primary care visits or generic prescription drugs.
25. In Kansas, Aetna CVS Health offers plan number 84600KS0130006 at or below the benchmark plan premium in rating area 1. Oscar Insurance Company offers plan number 43490KS0010052 at or below the benchmark plan premium in rating area 1, rating area 2, rating area 3, and rating area 7. Ambetter from Sunflower Health Plan offers plan number 34368KS0110069 at or below the benchmark plan premium in rating area 5 and rating area 6. These plans have no deductibles and no copays for primary care visits or generic prescription drugs.
26. In Kansas rating area 4, UnitedHealthcare offers plan number 94968KS0090004 at or below the benchmark plan premium. This plan has no deductible but has a $5 copay for primary care visits and a $1 copay for generic prescription drugs. While rating area 4 has no plans offered at or below the benchmark premium with no deductible and no copays for primary care visits and generic prescription drugs, UnitedHealthcare also offers plan number 94968KS0090008, which has no deductible and no copays for primary care visits and generic prescription drugs. The premium for this plan ranges from $1.71 more per month than the benchmark plan premium to $6.69 more per month, depending on the enrollee’s age.
27. In Mississippi, Cigna Healthcare offers plan number 56766MS0010011 at or below the benchmark plan premium in rating area 1, rating area 4, and rating area 5. Ambetter from Magnolia Health offers plan number 90714MS0010064 at or below the benchmark plan premium In rating area 2 and rating area 6. Molina Healthcare offers plan number 79975MS0010002 and plan number 79975MS0020002 at or below the benchmark plan premium in rating area 3. These plans have no deductibles and no copays for primary care visits or generic prescription drugs.
28. In South Carolina, Molina Healthcare offers plan number 42326SC0010002 at or below the benchmark plan premium in rating area 3, rating area 25, and rating area 40. First Choice Next offers plan number 73107SC0010003 at or below the benchmark plan premium in rating area 12 and rating area 29, and plan number 73107SC0010007 at or below the benchmark plan premium in rating area 12. Ambetter from Absolute Total Care offers plan number 79222SC0010032 at or below the benchmark plan premium in rating area 1, rating area 2, rating area 4, rating area 5, rating area 6, rating area 8, rating area 9, rating area 10, rating area 11, rating area 13, rating area 14, rating area 15, rating area 16, rating area 17, rating area 19, rating area 20, rating area 21, rating area 22, rating area 23, rating area 24, rating area 26, rating area 27, rating area 28, rating area 31, rating area 32, rating area 33, rating area 34, rating area 35, rating area 36, rating area 37, rating area 38, rating area 39, rating area 41, rating area 42, rating area 43, rating area 44, and rating area 46. These plans have no deductibles and no copays for primary care visits or generic prescription drugs.
29. In South Carolina rating area 7, Molina Healthcare offers plan number 42326SC0010010 at or below the benchmark plan premium. This plan has a $100 deductible and $2 copays for primary care visits or generic prescription drugs. While rating area 7 has no plans offered at or below the benchmark premium with no deductible and no copays for primary care visits and generic prescription drugs, Molina Healthcare also offers plan number 42326SC0010002, which has no deductible and no copays for primary care visits and generic prescription drugs. The premium for this plan ranges from $0.57 more per month than the benchmark plan premium to $2.25 more per month, depending on the enrollee’s age.
30. In South Carolina rating area 18, Molina Healthcare offers plan number 42326SC0010010 at or below the benchmark plan premium. This plan has a $100 deductible and $2 copays for primary care visits or generic prescription drugs. While rating area 18 has no plans offered at or below the benchmark premium with no deductible and no copays for primary care visits and generic prescription drugs, Ambetter from Absolute Total Care offers plan number 79222SC0010032, which has no deductible and no copays for primary care visits and generic prescription drugs. The premium for this plan ranges from $2.61 more per month than the benchmark plan premium to $10.29 more per month, depending on the enrollee’s age.
31. In South Carolina rating area 30, Molina Healthcare offers plan number 42326SC0010010 at or below the benchmark plan premium. This plan has a $100 deductible and $2 copays for primary care visits or generic prescription drugs. While rating area 30 has no plans offered at or below the benchmark premium with no deductible and no copays for primary care visits and generic prescription drugs, Ambetter from Absolute Total Care offers plan number 79222SC0010032, which has no deductible and no copays for primary care visits and generic prescription drugs. The premium for this plan ranges from $0.45 more per month than the benchmark plan premium to $1.77 more per month, depending on the enrollee’s age.
32. In South Carolina rating area 45, Molina Healthcare offers plan number 42326SC0010010 at or below the benchmark plan premium. This plan has a $100 deductible and $2 copays for primary care visits or generic prescription drugs. While rating area 45 has no plans offered at or below the benchmark premium with no deductible and no copays for primary care visits and generic prescription drugs, Molina Healthcare offers plan number 42326SC0010002, which has no deductible and no copays for primary care visits and generic prescription drugs. The premium for this plan ranges from $1.76 more per month than the benchmark plan premium to $6.96 more per month, depending on the enrollee’s age.
33. In Tennessee, Ambetter of Tennessee offers plan number 70111TN0110034 at or below the benchmark plan premium in rating area 1, rating area 4, and rating area 7, plan number 70111TN0150009 at or below the benchmark plan premium in rating area 4, and plan number 70111TN0160002 at or below the benchmark plan premium in rating area 6. Cigna Healthcare offers plan number 99248TN0060005 and plan number 99248TN0060111 at or below the benchmark plan premium in rating area 5. Oscar Insurance Company offers plan number 23552TN0020052 at or below the benchmark plan premium in rating area 8. These plans have no deductibles and no copays for primary care visits or generic prescription drugs.
34. In Tennessee rating area 2, BlueCross BlueShield of Tennessee offers plan number 14002TN0400182 at or below the benchmark plan premium. This plan has a $250 deductible and $5 copays for primary care visits and generic prescription drugs. While rating area 2 has no plans offered at or below the benchmark premium with no deductible and no copays for primary care visits and generic prescription drugs, BlueCross BlueShield of Tennessee also offers plan number 14002TN0400265, which has no deductible and no copays for primary care visits and generic prescription drugs. The premium for this plan ranges from $0.04 more per month than the benchmark plan premium to $0.18 more per month, depending on the enrollee’s age.
35. In Tennessee rating area 3, BlueCross BlueShield of Tennessee offers plan number 14002TN0400291 at or below the benchmark plan premium. This plan has a $250 deductible and $5 copays for primary care visits and generic prescription drugs. While rating area 3 has no plans offered at or below the benchmark premium with no deductible and no copays for primary care visits and generic prescription drugs, BlueCross BlueShield of Tennessee also offers plan number 14002TN0400293, which has no deductible and no copays for primary care visits and generic prescription drugs. The premium for this plan ranges from $0.06 more per month than the benchmark plan premium to $0.21 more per month, depending on the enrollee’s age.
36. In Texas, Baylor Scott and White Health Plan offers plan number 40788TX0460003 at or below the benchmark plan premium in rating area 1, rating area 3, rating area 8, rating area 11, rating area 14, and rating area 17. Ambetter from Superior HealthPlan offers plan number 29418TX0140108 at or below the benchmark plan premium in rating area 2, rating area 16, and rating area 20, plan number 87226TX0060011 at or below the benchmark plan premium in rating area 25, and plan number 87226TX0100011 at or below the benchmark plan premium in rating area 26 and rating area 27. Oscar Insurance Company offers plan number 20069TX0100052 at or below the benchmark plan premium in rating area 6, rating area 12, rating area 19, and rating area 24. CHRISTUS Health Plan offers plan number 66252TX0280003 at or below the benchmark plan premium in rating area 7 and plan number 66252TX0280001 at or below the benchmark plan premium in rating area 21. Blue Cross and Blue Shield of Texas offers plan number 33602TX0461174 at or below the benchmark plan premium in rating area 9, plan number 33602TX0461175 at or below the benchmark plan premium in rating area 10, plan number 33602TX0460691 at or below the benchmark plan premium in rating area 13, plan number 33602TX0461177 at or below the benchmark plan premium in rating area 18, and plan number 33602TX0461187 at or below the benchmark plan premium in rating area 23. These plans have no deductibles and no copays for primary care visits or generic prescription drugs.
37. In Texas rating area 4, some counties have access to plans offered at or below the benchmark plan premium with no deductible and no copays for primary care visits or generic prescription drugs, while others do not. Blue Cross and Blue Shield of Texas offers plan number 33602TX0460682 at or below the benchmark plan premium in Angelina County, Houston County, Nacogdoches County, Polk County, Sabine County, San Augustine County, San Jacinto County, Shelby County, and Trinity County. This plan has no deductible and no copays for primary care visits or generic prescription drugs. Blue Cross and Blue Shield of Texas offers plan number 33602TX0461092 at or below the benchmark plan premium in Hardin County, Jasper County, Jefferson County, Newton County, Orange County, and Tyler County. This plan has a $100 deductible, a $25 copay for primary care visits, and no copay for generic prescription drugs after the deductible. While Hardin County, Jasper County, Jefferson County, Newton County, Orange County, and Tyler County have no plans offered at or below the benchmark premium with no deductible and no copays for primary care visits and generic prescription drugs, Blue Cross and Blue Shield of Texas also offers plan number 33602TX0460682, which has no deductible and no copays for primary care visits and generic prescription drugs. The premium for this plan ranges from $1.23 more per month than the benchmark plan premium to $4.80 more per month, depending on the enrollee’s age.
38. In Texas rating area 5, some counties have access to plans offered at or below the benchmark plan premium with no deductible and no copays for primary care visits or generic prescription drugs, while others do not. Blue Cross and Blue Shield of Texas offers plan number 33602TX0460683 at or below the benchmark plan premium in Kenedy County and Willacy County. This plan has no deductible and no copays for primary care visits or generic prescription drugs. Blue Cross and Blue Shield of Texas offers plan number 33602TX0461093 at or below the benchmark plan premium in Cameron County. This plan has a $100 deductible, a $25 copay for primary care visits, and no copay for generic prescription drugs after the deductible. While Cameron County has no plans offered at or below the benchmark premium with no deductible and no copays for primary care visits and generic prescription drugs, Blue Cross and Blue Shield of Texas also offers plan number 33602TX0460683, which has no deductible and no copays for primary care visits and generic prescription drugs. The premium for this plan ranges from $1.13 more per month than the benchmark plan premium to $4.41 more per month, depending on the enrollee’s age.
39. In Texas rating area 15, some counties have access to plans offered at or below the benchmark plan premium with no deductible and no copays for primary care visits or generic prescription drugs, while others do not. Blue Cross and Blue Shield of Texas offers plan number 33602TX0460693 at or below the benchmark plan premium in Brooks County and Starr County. This plan has no deductible and no copays for primary care visits or generic prescription drugs. Blue Cross and Blue Shield of Texas offers plan number 33602TX0461134 at or below the benchmark plan premium in Hidalgo County. This plan has no deductible, no copays for primary care visit, and a $5 copay for generic prescription drugs. While Hidalgo County has no plans offered at or below the benchmark premium with no deductible and no copays for primary care visits and generic prescription drugs, Blue Cross and Blue Shield of Texas also offers plan number 33602TX0460693, which has no deductible and no copays for primary care visits and generic prescription drugs. The premium for this plan ranges from $1.10 more per month than the benchmark plan premium to $4.32 more per month, depending on the enrollee’s age.
40. In Texas rating area 22, UnitedHealthcare offers plan number 40220TX0080025 at or below the benchmark plan premium. This plan has no deductible, no copays for primary care visits, and a $2 copay for generic prescription drugs. While rating area 22 has no plans offered at or below the benchmark premium with no deductible and no copays for primary care visits and generic prescription drugs, UnitedHealthcare also offers plan number 40220TX0080020, which has no deductible and no copays for primary care visits and generic prescription drugs. The premium for this plan ranges from $3.03 more per month than the benchmark plan premium to $11.91 more per month, depending on the enrollee’s age.
41. In Wisconsin, Anthem Blue Cross and Blue Shield offers plan number 79475WI0340170 at or below the benchmark plan premium in rating area 1, plan number 79475WI0340180 at or below the benchmark plan premium in rating area 9, plan number 79475WI0530009 at or below the benchmark plan premium in rating area 10, plan number 79475WI0340181 at or below the benchmark plan premium in rating area 11, and plan number 79475WI0340232 at or below the benchmark plan premium in rating area 14. Dean Health Plan offers plan number 38345WI0080069 at or below the benchmark plan premium in rating area 2 and rating area 15. Medica offers plan number 57845WI0040057 at or below the benchmark plan premium in rating area 3, plan number 57845WI0050057 at or below the benchmark plan premium in rating area 3 and rating area 6, and plan number 57845WI0060057 at or below the benchmark plan premium in rating area 5. Security Health Plan offers plan number 38166WI0180027 at or below the benchmark plan premium in rating area 4 and rating area 8, plan number 38166WI0310003 at or below the benchmark plan premium in rating area 4, and plan number 38166WI0270012 at or below the benchmark plan premium in rating area 8 and rating area 10. HealthPartners offers plan number 20173WI0130034 at or below the benchmark plan premium in rating area 13. Common Ground Healthcare Cooperative offers plan number 87416WI0030047 at or below the benchmark plan premium in rating area 16. These plans have no deductibles and no copays for primary care visits or generic prescription drugs.
42. In Wisconsin rating area 7, some counties have access to plans offered at or below the benchmark plan premium with no deductible and no copays for primary care visits or generic prescription drugs, while others do not. Dean Health Plan offers plan number 38345WI0010163 at or below the benchmark plan premium in Crawford County, Grant County, Lafayette County, and Vernon County. This plan has no deductible and no copays for primary care visits or generic prescription drugs. Dean Health Plan offers plan number 38345WI0010157 at or below the benchmark plan premium in Iowa County. This plan has a $100 deductible and $5 copays for primary care visits or generic prescription drugs. While Iowa County has no plans offered at or below the benchmark premium with no deductible and no copays for primary care visits and generic prescription drugs, Dean Health Plan also offers plan number 38345WI0010163, which has no deductible and no copays for primary care visits and generic prescription drugs. The premium for this plan ranges from $2.55 more per month than the benchmark plan premium to $10.05 more per month, depending on the enrollee’s age.
43. In Wisconsin rating area 12, UnitedHealthcare offers plan number 80180WI0100008 at or below the benchmark plan premium. This plan has no deductible, a $5 copay for primary care visits, and a $1 copay for generic prescription drugs. While rating area 12 has no plans offered at or below the benchmark premium with no deductible and no copays for primary care visits and generic prescription drugs, UnitedHealthcare also offers plan number 80180WI0100005, which has no deductible and no copays for primary care visits and generic prescription drugs. The premium for this plan ranges from $1.31 more per month than the benchmark plan premium to $5.19 more per month, depending on the enrollee’s age.
44. In Wyoming, Blue Cross Blue Shield of Wyoming offers plan number 11269WY0170018 at or below the benchmark plan premium in rating area 1, rating area 2, and rating area 3. This plan has no deductible and no copays for primary care visits or generic prescription drugs.
45. Authors’ calculations based upon data provided by the U.S. Department of Health and Human Services on every lowest-cost and benchmark Silver plan offered in every rating area in every non-expansion state.
46. Ibid.
47. Ibid.
48. Ibid.
49. Authors’ calculations based upon data provided by state workforce agencies on the statewide average entry-level wage and the U.S. Department of Health and Human Services on the federal poverty level for a single individual in 2024.
50. Medicaid and CHIP Payment and Access Commission, “Physician acceptance of new Medicaid patients: Findings from the National Electronic Health Records Survey,” Medicaid and CHIP Payment and Access Commission (2021), https://www.macpac.gov/wp-content/uploads/2021/06/Physician-Acceptance-of-New-Medicaid-Patients-Findings-from-the-National-Electronic-Health-Records-Survey.pdf.
51. Ibid.
52. Ibid.
53. Hayden Dublois and Michael Greibrok, “Medicaid expansion dramatically increases hospital shortfalls…And puts their futures at risk,” Foundation for Government Accountability (2024), https://thefga.org/research/medicaid-expansion-dramatically-increases-hospital-shortfalls.
54. Ibid.
55. Paige Terryberry, “Medicaid expansion deceives states and harms the truly needy,” Foundation for Government Accountability (2024), https://thefga.org/research/medicaid-expansion-deceives-states.
56. Hayden Dublois and Michael Greibrok, “Medicaid expansion dramatically increases hospital shortfalls…And puts their futures at risk,” Foundation for Government Accountability (2024), https://thefga.org/research/medicaid-expansion-dramatically-increases-hospital-shortfalls.
57. Ibid.
58. Ibid
59. Ibid.
60. Ibid.
61. Ibid.
62. Center for Healthcare Quality and Payment Reform, “Rural hospitals at risk of closing,” Center for Healthcare Quality and Payment Reform (2024), https://chqpr.org/downloads/Rural_Hospitals_at_Risk_of_Closing.pdf.
63. Ibid.
64. Paige Terryberry, “Medicaid expansion deceives states and harms the truly needy,” Foundation for Government Accountability (2024), https://thefga.org/research/medicaid-expansion-deceives