Sarah Miller

 

Medicaid and the Affordable Care Act

Where are we coming from and

where are we going?

Business Economics

Three (Recent) Eras of Health Care

Pre-ACA

• Combination of government provided, employer sponsored, and uninsured
• Minimal non-group coverage
• Gaps by income
• Erosion of coverage as costs increased

Source: 2011 CPS ASEC, Non-Elderly Only

Employer-Sponsored Health Insurance

Uninsured

Medicaid/Public

Non-group

Affordable Care Act

• Increase health insurance coverage
• Reduce health care costs
• Improve quality

Coverage Expansions

1.Young adults allowed to stay on their parents’ private insurance until age 26 (effective September 2010)

 

2.Eligibility for Medicaid extended to everyone with incomes below 138% of the Federal Poverty Level (effective Jan 2014*)

 

3.New tax credits for private insurance for families between 100 and 400% of the Federal Poverty Level (effective Jan 2014)

 

4. Individual mandate to purchase health insurance (now repealed)

 

5. Guaranteed issue

Medicaid Expansion

 

Source: KFF

 

• High profile supreme court case challenging constitutionality of the ACA
• Because of this ruling, states could opt not to expand Medicaid without risking losing additional funding.

• The goal: make it easier to shop for health insurance if you don't have coverage through an employer
• Consumers shop for standardized plans.
• Low-income consumers are subsidies (premiums capped at % of income)

Health Insurance Marketplaces

Individual mandate repealed

More states adopt Medicaid expansions

Subsidies to buy health insurance coverage are more generous

Changes under Trump/Biden

Trends in Coverage

• Highest insurance coverage rate in years
• 22M gain coverage
• Still many left uninsured!

Trends in Cost

• As percent of GDP
• Source: KFF

Discussion