‘ObamaCare has turned out to be a giant welfare program, with millions of working- and middle-class Americans improperly receiving Medicaid…’
A recently released national study by the National Bureau of Economic Research validates their apprehension.
The study, “Medicaid Coverage Across the Income Distribution Under the Affordable Care Act,” compared North Carolina and 11 other states that did not expand Medicaid to nine expansion states.
Research findings showed large additions to Medicaid did not conform to Obamacare’s intent—providing uninsured individuals with previously unavailable private health-insurance options.
Many consumers who were eligible for government-subsidized private health-insurance plans grabbed Medicaid coverage instead. Medicaid has larger tax-paid subsidies for co-pays and deductibles, and no premiums.
But about half of Medicaid enrollees were not eligible because their income was above the cap of 138 percent of the federal poverty level.
Numbers for the study were drawn from the American Community Survey, conducted by the U.S. Census Bureau, for the first four years of the Affordable Care Act rollout through 2017.
The nine expansion states in this study were Arkansas, Kentucky, Michigan, Nevada, New Hampshire, New Mexico, North Dakota, Ohio and West Virginia.
“Overall, more than 2.4 million non-elderly adults gained coverage in these nine states between 2012 and 2017; a 10.4 percentage point increase. Medicaid coverage alone increased 7.2 percentage points, or approximately 1.7 million non-elderly adults,” the study said.
“Of these, around 800,000 individuals (around 43%) appeared to gain Medicaid coverage for which they were seemingly income-ineligible. In principle, many would be eligible for subsidized private coverage through the Marketplace,” it said.
The non-expansion states in the study were Alabama, Florida, Georgia, Kansas, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, South Dakota, Texas and Wyoming.
The study said in those states 4 million non-elderly adults gained some form of insurance coverage between 2012 and 2017. About 227,000, or 6 percent, gained coverage via Medicaid.
While that pales in comparison to expansion states, 54 percent of those added to Medicaid rolls appeared to be income-ineligible.
The study authors offered several potential reasons for the incongruity, including states not complying with the federal rules in determining eligibility.
Alternatively, consumers might be deliberately under-reporting their income, or are confused about how to calculate it. Caseworkers might be aware that people are not reporting their full income, but choose not to disqualify them, or could be making paperwork mistakes.
“We find that the 2014 Medicaid expansions led to a 3.0 percentage point increase in Medicaid enrollment among working-age adults with incomes at or above 138% of the FPL [federal poverty level], a sizable effect from a baseline rate of 2.7%,” the study authors wrote.
That equates to about 522,000 income-ineligible enrollees in the nine expansion states, which was 47 percent of the entire gain in insurance coverage for these relatively higher income adults.
North Carolina has been among battleground states where state and national pressure has been brought to bear on efforts to grow Medicaid rolls.
Democratic Gov. Roy Cooper vetoed the state budget because it did not expand Medicaid for up to 600,000 people.
Legislative Democrats are not breaking ranks with the governor to give Republicans enough votes for a veto override. The state has been operating under a continuation budget for 42 days.
North Carolina’s Medicaid program already is riddled with program errors and ineligible participants. Republican lawmakers have resisted calls to expand the program until those trouble spots are fixed, although some House Republicans have pushed for a form of Medicaid expansion.
North Carolina State Auditor Beth Wood released an audit in April showing the state Department of Health and Human Services improperly paid more than $100 million in Medicaid claims during fiscal year 2018.
Of that total, $29.1 million was paid for ineligible beneficiaries due to incorrect and inadequately documented eligibility determinations. A 2017 statewide audit also found significant errors in determining new Medicaid eligibility and redeterminations of existing participants.
North Carolina Senate leader Phil Berger’s office sent out a press release Monday citing a Wall Street Journal op-ed column by the study authors calling for action.
“ObamaCare has turned out to be a giant welfare program, with millions of working- and middle-class Americans improperly receiving Medicaid—a reflection of the unpopularity of the exchange policies and incompetence of government oversight,” the op-ed said.