State Medicaid expansion decisions largely influence cities, as most have low-income populations who would qualify under expanded eligibility, according to a new issue brief from the Robert Wood Johnson Foundation.
The RWJF looked at 14 large, diverse cities: Los Angeles; Chicago; Houston; Philadelphia; Phoenix; Indianapolis; Columbus, Ohio; Charlotte, North Carolina; Detroit; Memphis, Tennessee; Seattle; Denver; Atlanta and Miami.
Among the seven cities in expansion states, the uninsured rate will drop by an average of 56.5 percent. And among the seven cities in nonexpansion states, the uninsured rate will fall by an average of 29.7 percent. If the latter seven cities expand Medicaid eligibility, the average number of uninsured residents would drop by 52 percent.
All 14 cities will receive new federal funds thanks to the ACA, but the amount depends on if their state decides to expand Medicaid. With more than 50 percent of the uninsured population in all but one of the 14 cities eligible for Medicaid or income-related subsidies under expansion, the RWJF brief notes their economies stand to benefit greatly.
The RWJF also found ACA implementation will send Medicaid and CHIP enrollment increasing by an average of 38.5 percent in the seven Medicaid expansion cities and 10.7 percent in the seven nonexpansion cities. Enrollment growth in the nonexpansion cities likely comes from the individual mandate boosting sign-ups among individuals already eligible for Medicaid and CHIP.
Similarly, a May analysis from Avalere Health found 17 states that chose to not expand Medicaid experienced a surge in enrollment, thanks in part to the woodwork effect of increased public awareness and outreach. During last-minute efforts to increase enrollment, more than 550,000 Medicaid-eligible people who weren't previously enrolled signed up in those 17 states between October and March.
- read the RWJF brief (.pdf)