Fun With Numbers

The Affordable Care Act  maintained existing Medicaid coverage for low income children. Whether or not their parents will have coverage is being left up to the states.
In Indiana, that’s a problem.
As a recent report from the Institute for Working Families explains, right now, Indiana only covers working parents who make up to 24 percent of the poverty line, which comes to $4,581 a year for a family of three. The Medicaid expansion provision in the Act encourages coverage for these low income adults by expanding Medicaid to 133 percent of the poverty line ($25,390 for a family of three).  According to a recent study by the non-partisan Kaiser Commission on Medicaid and the Uninsured–a study which is consistent with Congressional Budget Office’s estimates– 215,803 previously uninsured Hoosiers would have access to care by 2019–if Indiana implements that provision of the Act.
And why wouldn’t we?  The Act provides 100 percent federal funding for the expansion of Medicaid for its first three years, phasing down after that to 90 percent federal funding by 2019.  According to the same study by Kaiser, this will cost Indiana $478 million from 2014-2019 (an average of $79 million each fiscal year).
Interestingly, in a study commissioned by the State of Indiana, the estimated cost (2.58 billion) is approximately 5 times greater than the cost shown by the non-partisan Kaiser study (478 million).
What the Indiana study evidently ignores are the savings involved: Medicaid expansion would save the state substantial amounts we now pay for uncompensated care for the uninsured. We pay those costs two ways: through our tax dollars, and through higher premiums charged to those who are insured. (In fact, according to Kaiser, during the 2014-2020 time period, each insured Hoosier will otherwise pay over $2000 to subsidize the uninsured.)
Let’s try an analogy: let’s say you’ve been taking a bus to work, and you and a couple of friends buy a car. Your share of the car expenses will be 150. a month. The cost to you will thus be 150 per month minus the 40 bucks a month you’ve been spending on the bus. This is a concept called net cost. 
If the state refuses to expand Medicaid, people with incomes between 100 percent and 400 percent of the poverty line will be eligible for subsidies to help them afford coverage in the new health insurance exchanges.  But people below the poverty line won’t receive coverage at all, since the Affordable Care Act assumes they’re covered by Medicaid.
That seems deeply unfair–even immoral.
My question is: why is depriving these people of coverage so important a goal that the Daniels Administration is willing to issue a deceptive analysis of the costs involved?


  1. Of professional interest to me is the effect this has on jail medical expenses. Currently, counties have to pay to treat the serious medical needs of inmates in the custody of their jails. You can’t just let them go untreated, even if that’s what would have happened if they were not in jail.

    A lot of these people would be covered by Medicaid under the expansion, but not currently. That would mean that Medicaid and not the county picks up the tab.

    I think.

  2. Sheila – thanks for shining a light on the tradoffs of the Affordable Care Act aka Obamacare.
    I hope you’ll do more ‘enlightening’. It’s a program of such girth that few understand the broad range of its provisions.

    And thank you, thank you, thank you for your attention to how the insured also benefit from the ACA — something very few mention but is of utmost benefit to the individuals and companies who pay health insurance premiums.

    You’ve correctly highlighted the cost to premium payers for the cost-shifting from the uninsured to the insured. If those who couldn’t get insurance before can now qualify for coverage and pay their own premiums, the rest of us won’t be billed for the uninsured too.

    I hope you’ll provide MORE info on ACA. The disinformation on this legislation is everywhere, and you’ve rightly shined a light on the facts.

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