Dive Brief:
- Millions more low-income people than anticipated are enrolling in public healthcare coverage rather than subsidized private plans available under the ACA, according to a new report by the Congressional Budget Office.
- The report estimates enrollment in Medicaid and the Children's Health Insurance Program will reach 68 million in 2016, which is 16 million above what was anticipated when the Affordable Care Act was passed.
- It is projected the higher enrollment will increase Medicaid costs by $146 billion more than originally planned, even though the original cost estimate was for all states, and there are 19 states still not participating in Medicaid expansion.
Dive Insight:
The high Medicaid enrollment can be expected to have ramifications for Medicaid expansion and the ACA's private marketplace plans, experts suggest.
Regarding expansion, the high enrollment and the higher cost it brings may justify some state lawmakers' concerns about longterm program affordability, and contribute to the hold-out states continuing their resistance. At the same time, however, the CBO report notes much of the new Medicaid enrollment comes from people in non-expansion states, who likely either hadn't known they were already eligible, or were just signing up recently to try to fulfill the federal mandate for insurance coverage.
Meanwhile, the report highlights that enrollment in subsidized ACA plans by low- and middle-income people is at just 12 million, far below the projected 21 million.
Some of the reasons put forth are the costs of ACA plans, the continued availability of employer health plans, and the ability under Medicaid to enroll at any time.