Why Florida Should Expand Medicaid

Why Florida Should Expand Medicaid

Type: 
News

 

by Diane Dimperio

Introduction

The Affordable Care Act (ACA), passed into law in 2010, was designed to improve the health of Americans. A key strategy in the law is improving access to health care which, in America, means providing affordable high quality health insurance. Florida Medicaid eligibility is limited to specific populations like pregnant women and children, but the ACA offers the opportunity to expand Medicaid to low-income adults. Florida is one of only 10 states that has not expanded Medicaid, so it should not be surprising that it ranked 47th in the percentage of residents with insurance (United Health Foundation, n.d.) and 48th in the nation for access to care (US News & World Report, n.d.). This paper presents a summary of just a few of the many studies describing the reasons Florida should expand Medicaid.

Improved Health

People who enroll in Medicaid Expansion (MedEx) participate in primary care which includes preventive care, screening and referral for needed services (Clark, S. et al., 2018). Participants are more likely to get flu shots and mammograms (Glied & Weiss, 2023), less likely to use the emergency room (Sabbitini & Dugan, 2022) and smokers are referred to cessation services (Koma et al., 2017; Maclean et al., 2018). Participation in MedEx improves women’s health before, during and after pregnancy (Guth & Diep, 2023).

People with chronic conditions receive needed interventions (Sommers et al., 2017; Cole et al., 2018; Ohio Department of Medicaid, 2016) which improves health, such as normalizing high blood pressure and cholesterol (Ohio Department of Medicaid, 2016). MedEx has a positive impact on adults with serious health issues such as cancer and end stage renal disease because they are diagnosed and treated earlier (Soni et al., 2018) so they have lower rates of morbidity and mortality (Hotcha et al., 2023; Swaminathan et al., 2018). People needing surgery can be seen before their condition becomes severe (Loeher et al., 2018) and have better post operative outcomes (Charles et al., 2017). Reviews of national data demonstrate that MedEx is associated with decreased disease related mortality (Miller et al., 2021) and all case mortality (Lee et al, 2022).

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Reduced Disparities

Disparities in health outcomes among some populations such as rural residents and people of color are well documented. Although enrollment in MedEx does not eliminate health disparities, it reduces the severity.

Rural participants enrolled in MedEx report improved access to primary care, receipt of preventive screenings, participation in disease management and improved quality of care. They also report feelings of greater financial security, better overall health and happiness (Allen et al., 2018; Sommers et al., 2016).

Minorities, especially those of African American descent, generally have worse health outcomes than whites. This disparity is particularly pronounced in birth outcomes. In Florida, in 2022, mortality among Infants born to African American mothers was 11.2/1000 births and among white women was 4.3/1000 births (Florida Department of Health Division of Public Health Statistics and Performance Management, n.d.). Expanding Medicaid results in a significant decrease in infant mortality with the greatest improvement being among infants of Black mothers (Bhatt & Beck-Sagué, 2018). MedEx also results in a significant decrease in maternal mortality (Eliason, 2020).

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Early Diagnosis and Treatment for Mental Health and Substance Use Disorder

Primary care includes screening and referral for and treatment of mental health and substance use disorder. For example, almost 36% of those enrolled in Ohio’s MedEx suffered from undiagnosed depression. They were able to access appropriate treatment and were less likely to die from drug overdoses (Ohio Department of Medicaid, 2016).

A study of national death files kept by the Center for Disease Control and Prevention found expansion states experienced 30% fewer heroine deaths and a 26% reduction from other narcotics related deaths (McInerey, 2019).

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Improved Financial Status

MedEx improves the financial status of enrollees. They spend less on health care (Glied et al., 2017), so they can afford to buy food, pay the rent/mortgage, etc. (Ohio Department of Medicaid, 2016). They are less likely to borrow money or miss payments (Baicker & Finkelstein, 2011) and file for bankruptcy which results in improved credit scores (Brevoort et al., 2017; Caswell & Waidmann, 2019).

One study found a positive correlation between MedEx and volunteering which is considered an indicator of “better health and financial security” (Sohn and Timmermans, 2017).

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Higher Rates of Employment

Enrollees report they are able perform better at work, and those out of work, report they were better able to seek employment (Tipirneni et al., 2019; Ohio Department of Medicaid, 2016). MedEx supports employment because healthy people are more able to work and access to health insurance attracts and retains employees (Guth et al., 2023). The Small Business Majority, an advocacy organization representing small businesses, supports MedEx as one of its policy priorities for 2024 (Small Business Majority, n.d.).
National studies find states that expanded Medicaid have higher rates of employment than states that did not (Callison & Sicilian, 2016; Lee et al., 2023). Uncoupling insurance from employment promotes economic freedom and market efficiency. The specific impact of MedEx on employment varied by demographics, but the greatest increase in employment associated with MedEx was among black men (Callison & Sicilian, 2016).

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Positive Impacts on Local Communities

Hospitals must accept anyone who needs care and are sometimes referred to as the “insurer of last resort”. Services provided to uninsured patients often result in uncompensated care, which will affect a hospital’s fiscal health. Hospitals in states that did not expand Medicaid were more likely to close than those in states that expanded Medicaid (Lindrooth et al., 2018).

County governments use local tax dollars to pay for medical and behavioral health services for low-income uninsured adults who would be eligible for expanded Medicaid. Even a medium sized county, like Alachua, could save as much as $3 million annually.

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Benefit to the State Budget

How much will all these benefits cost Florida taxpayers? When the ACA passed the costs needed to support the program, including MedEx, were estimated and personal and business taxes adjusted to pay for the program. The tax adjustments assumed all states would participate in MedEx. So Florida tax payers have been paying for MedEx for over a decade. So the state budget will incur no additional costs. The detail on how this works is explained below.

The state pays about 40% of the cost of “Regular Medicaid” and the federal government pays about 60%. The federal government pays 90% of the cost of MedEx, so the state only pays 10%. It is estimated the state of Florida will pay $442 M for MedEx. But some people currently enrolled in Regular Medicaid will be transferred to the MedEx program, which will reduce state expenses by $266M. The current state budget also includes funding for health care services that will be covered by Medicaid and therefore eliminated, which saves an additional $355M. The state charges health providers a tax on their income. Their income will increase which will generate $19M additional revenue. Therefore, the state budget will benefit by $198M each year. As an incentive to encourage states to expand Medicaid the Biden administration has added a bonus payment for the first 2 years of expansion. This is expected to generate an additional $1.96B (Florida Decides Health Care, n.d.; Swerlick, 2021).

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Stimulus for the State Economy

Expanding Medicaid to the 726,000-799,000 Floridians who are now uninsured will generate an influx of over $4 billion of federal revenue (from Florida taxes) into the state (Childers, 2020). This is expected to support 130,000 new jobs in health care (Florida Decides Health Care, n.d.). Economists tell us that every federal dollar added to the economy creates between $1.50 to $1.70 in economic activity (Chernew, 2016). This increase in new federal funds from Medicaid expansion will translate into a $6.15 to $7.29B stimulus for Florida’s economy (Childers, 2020).

Although this sounds too good to be true, these estimates are consistent with reports from expansion states. An evaluation on MedEx in Montana said, “Medicaid expansion has a substantial effect on Montana’s economy…[it] ripples through Montana’s economy, generating approximately 5,000 jobs and $270 million in personal income each year…. MedEx appears to improve outcomes for Montanans—reducing crime, improving health, and lowering debt…. [C]osts to the state budget are more than offset by the savings created by Medicaid expansion and by the revenues associated with increased economic activity” (Ward & Bridge, 2018). Michigan and other states report similar experiences (Ayanian et al., 2017; Ward, 2020; Gruber & Sommers, 2020).

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References

Issues referenced by this article: 
Amendment Proposals
Health Care Reform
This article is related to which committees: 
Health Care
League to which this content belongs: 
Alachua County