Around 6.3 million individuals have been determined eligible for Medicaid or the Children Health Insurance Program from October 1st through December 31 of last year, according to a new report from the Center for Medicare and Medicaid Services (CMS). The new data highlights applications and determinations for both programs since the launch of Healthcare.gov and the state-run insurance exchanges, though the total number also includes information reported through existing state agencies.
CMS cautions that the numbers are preliminary, and the report is strewn with several caveats that make analysis below the top-line number ill-advised. Because states are still transitioning to a more simplified reporting process the number reported Wednesday includes those individuals newly enrolled and, from some states, those people that have had their existing coverage renewed. Moreover, some states, like Florida, have separate state agencies for their CHIP program whose numbers were not included in this report.
That being said, most of the states reporting data also provided a baseline for comparison, and in regard to those states that have expanded Medicaid and those that have declined, one particular section stands out:
Looking at the 41 states that reported both December determinations and baseline data for this indicator, December determinations were up 73% as compared to the July through September 2013 period in states expanding Medicaid and up 3% in those states not expanding Medicaid.
Health care expert Timothy Jost, providing a response to CNBC, suggested that the high percentage probably means “that a big chunk of the Medicaid sign-up reported Wednesday are due to new enrollees.” How much is, again, impossible to determine based on the report alone. As I wrote in a post yesterday, Kevin Drum was estimating that proportion at around two-thirds (before these new numbers were released).
Yet if a 73 percent determination uptake is indicative of the Medicaid expansion’s enrollment effects, then the 3 percent in states that aren’t expanding might indicate the weakness of the “woodwork” effect — in which some thought the Affordable Care Act might induce previously eligible individuals into the existing Medicaid/CHIP programs in non-expanding states. This was a particular concern of Governors who opposed the expansion after the Supreme Court ruled that portion of the law voluntary, according to an analysis last year in the New England Journal of Medicine. This aspect is still probably occurring to some extent, but these new numbers don’t present a convincing case that the effect is substantial thus far.
Like much of the existing data on the health care law’s implementation this new information only goes so far. It will be, for any serious consideration, quite some time before any broad, solid, conclusions can be drawn from this initial enrollment period.
Also see Sarah Kliff’s piece on the CMS report. One important part on when we’ll have better data:
The question on health wonks’ minds is: How many people got Medicaid under Obamacare? We don’t have that answer until the early spring. Each quarter, states submit reimbursement requests to the federal government. The end of the first quarter of the year is March 31. That’s when states will tell the federal government how much they should be paid for each person they cover on Medicaid. That’s where states will have to specify who gained coverage under the health-care law, because the federal government will pay 100 percent of those enrollees’ costs. Typically the federal government only splits the bill with the state.
Similarly, read Jonathan Cohn on the new Gallup estimate of the uninsured rate, which dropped from December:
Hooray! But wait—upon closer inspection, the data turns out to be pretty murky. One reason the uninsurance rate dropped so sharply is that, according to Gallup, it rose substantially during the first part of 2013. […]
That unexplained volatility makes it difficult to put much stock in the results. In other words, you shouldn’t read too much into these figures—or, for that matter, any figures you are hearing these days.
Note: Originally posted at The McLean Parlor.