Steve Pizer says Senator Berger misreads his study
February 14, 2013 4 Comments
Senator Berger says in today’s News and Observer that the Medicaid expansion available via the Affordable Care Act will not expand insurance coverage by ~500,000 persons as analysts have claimed. He cites a study conducted by researchers from Boston University and Harvard, two of whom are friends and colleagues of mine (and I used to blog with them). I asked the studies lead author what he thought of Senator Berger’s claim based on his research, and here is what he (Steve Pizer) wrote to me:
Although it’s true that Medicaid expansion nationally will result in substantial numbers of individuals moving from private to public insurance, in a state like North Carolina this will be much less of a problem. North Carolina has relatively high uninsurance rates and currently restrictive Medicaid eligibility policies. This means new Medicaid enrollees in North Carolina will have lower incomes and be more likely to be uninsured than in many other states. In related research with the same colleagues as the study cited by the Senate President, we demonstrated that low-income individuals with chronic health conditions like diabetes and asthma and/or disabilities like difficulty walking are disproportionately likely to be uninsured in states with restrictive Medicaid eligibility policies like North Carolina. The proposed Medicaid expansion would be an effective means to reduce uninsurance in this vulnerable population as well as among the low-income population more generally.
In other words, the Medicaid expansion will be more efficient at covering the uninsured in some states as compared to others. States with relatively low eligibility standards will get more insurance bang out of the Medicaid expansion than others. North Carolina is one such state, simply because our current Medicaid eligibility levels are so low (a childless adult can NEVER qualify for Medicaid today in North Carolina,no matter how low their income; see table 3). In Massachusetts, the Affordable Care Act is in many ways is irrelevant because of what the state had already done, for example. Not so in North Carolina, because of what we have not done by way of voluntary Medicaid expansions.
The bottom line of the Supreme Court’s decision making Medicaid ACA expansion voluntary was to say to states like North Carolina, “you don’t have to take money to expand health insurance from California, New York and Massachusetts if you don’t want to.” Our elected leaders are saying just that, which is in their power.
However, I expect to hear something other than what they are against.What is their alternative? What are they for? Where are the costs of uncompensated care going to be shifted if not covered by Medicaid? How much will this cost the state? You get the idea…