ATLANTA: The cost of expanding Medicaid under President Barack Obama’s health care overhaul is rising faster than expected in many states, causing budget anxieties and political misgivings.
Far more people than projected are signing up under the new, more relaxed eligibility requirements, and their health care costs are running higher than anticipated, in part because the new enrollees are apparently sicker than expected. Rising drug prices may also be a factor.
As a result, at least three expansion states, Arkansas, Kentucky and Ohio, have been pushing to require Medicaid recipients to pay more toward their health insurance — a step that some experts say could lead tens of thousands of poor people who can’t afford the extra cost to drop off the Medicaid rolls and go without coverage. Contrary to common perceptions, Medicaid coverage isn’t always free — many states require modest copayments.
The soaring tab for the state-federal program could also harden opposition to expansion in the 19 states that have yet to sign up. The situation will be one of the thorny issues the next president will have to address, with the health care of millions of Americans hanging in the balance.
Thirty-one states and the District of Columbia have opted to expand the program for poor and lower-income Americans as part of the Affordable Care Act, helping to greatly reduce the number of people without coverage. The federal government has been picking up the entire tab for the new enrollees, but states will begin paying a 5 percent share in January, and that will rise to 10 percent by 2020.
While that may not sound like a lot, it can add up to tens of millions of dollars per state.
Arkansas — where more than 307,000 people have signed up for the expansion — is asking the federal government for permission to charge some new Medicaid recipients premiums to help cover the costs. Some lawmakers want to kill the expansion altogether.
“The facts are, it is what every other [Medicaid] program has been — a fiscal failure,” said state Sen. Bart Hester, a Republican.
In Kentucky, a state struggling to manage its pension debt, Republican Gov. Matt Bevin is asking for federal authorization to charge Medicaid enrollees up to $15 a month. He also wants to require some of them to perform “community engagement,” which would include working or volunteering.
Kentucky officials have estimated the proposed changes could result in at least 86,000 people dropping off the Medicaid rolls by 2021. One of them is Steve Olshewsky.
He makes about $9,000 a year teaching online classes and said he could not afford a monthly premium. He has struggled with depression and said he is doing better since he enrolled in Medicaid.
“I’m happy with my life,” he said. “But if you pull this rug out from under me, that’s the end of that story.”
In Ohio, nearly 715,000 people had enrolled under the expansion as of August, way beyond the original estimates of roughly 447,000 by fiscal year 2020. Ohio had to budget more than double the $55.5 million it estimated the new enrollees would cost in the coming fiscal year. The situation grew more urgent after federal officials last month rejected Ohio’s plan to charge some people as much as $99 a year.