Reform Update: Newly eligible Medicaid enrollees healthier than current beneficiaries, study finds

Americans newly eligible to receive Medicaid coverage in states that have opted to expand their coverage beginning next year overall are likely to be healthier than current Medicaid beneficiaries, a study found. And that could significantly lower the cost to the federal government and the states of the coverage expansion.

The study, published in the latest issue of the Annals of Family Medicine, found that newly eligible people are more likely to have an overall better health status than current beneficiaries, with 75% in “very good” or “good” health compared with 65% of current Medicaid recipients having “very good” or “good” health.

Researchers at the University of Michigan found that people who will be eligible for the program through the expansion are likely to have lower rates of obesity and depression than current enrollees, and will on average be younger and more likely to be white and male.

“The national estimate for the cost of Medicaid expansion is based current enrollees,” said study co-author Dr. Tammy Chang. “Our study shows that likely the newer enrollees are going to have less chronic disease, and so providing healthcare may have lower than expected costs.”

The findings showed higher rates of smoking and alcohol consumption among newly eligible enrollees compared with current Medicaid recipients.

But Chang said the Medicaid expansion will give healthcare professionals an opportunity to work with new Medicaid beneficiaries on changing their behavior before serious medical conditions develop. “As a family physician we see a lot of complicated Medicaid patients,” Chang said. “It would be wonderful to have newly eligible Medicaid patients who are healthy now but maybe have some health behaviors we can work on.”

Nearly half the states have refused to expand their Medicaid programs to adults earning up to 138% of the federal poverty level as authorized by the Patient Protection and Affordable Care Act. Republican leaders in those states have argued have contended the expansion would be too expensive for their states, even though the federal government would pay 100% of the cost of the expansion for the first three years and 90% after that.

But the study, which used data collected from the National Health and Nutrition Examination Survey, suggests the costs of providing health coverage for the millions expected to be added to the program may not be as high as previously projected.

A 2012 study by the Kaiser Family Foundation estimated the Medicaid expansion would increase total state spending on the program by $76 billion through 2022. The Congressional Budget Office projects 13 million people will become eligible for Medicaid by 2022.

If new Medicaid members are younger and healthier, that could change how healthcare providers view serving Medicaid patients, because they would be less costly and time-consuming to care for, she said.

Medicaid expansion opponents in Arizona have until Wednesday to get the more than 86,000 signatures needed to temporarily block the expansion approved by the Legislature and get a referendum for its repeal on the ballot in November 2014.

Reports indicate that as of Monday, a petition to block the newly passed legislation that is expected to provide health coverage for 300,000 low-income residents was about 5,000 signatures short.

Petition organizers have reportedly said they would likely not file the petition if they did not reach their goal by Wednesday's deadline.

If the petition drives fails to gather enough signatures to place the repeal initiative on the ballot, some conservatives have promised to file a lawsuit to block the Medicaid expansion legislation on the basis that it's a tax increase requiring approval by a legislative supermajority under the state constitution.

Medicaid expansion advocates in Ohio have begun taking steps to put an initiative on the ballot in 2014 to expand the program, given the inability of lawmakers thus far to pass legislation that would see an estimated 300,000 residents get coverage. Republican Gov. John Kasich supports the expansion but many GOP lawmakers have opposed it.

Last week the group Healthy Ohioans Work submitted a petition to start the process of getting an expansion proposal on the ballot.

Upon its review, if the attorney general accepts the proposal as valid then petitioners would have to get more than 100,000 signatures to get it before the legislature for consideration.

But the office of Ohio's Republican House Speaker William Batchelder said the ballot initiative might not be necessary. His spokesman said the House is moving to pass some version of a Medicaid expansion when members return to session in October.

Follow Steven Ross Johnson on Twitter: @MHSjohnson