Moving to another state with expanded health insurance eligibility isn't a choice waves of low-income Americans have made, and interstate migration isn't a major cost driver for states that expand Medicaid under the Affordable Care Act, according to a new Health Affairs study.
These findings refute what's called the "welfare magnet hypothesis," which holds that geographic variation in social programs causes welfare recipients--especially those with complex healthcare needs--to move to areas with richer benefits or easier-met eligibility rules. If that hypothesis proved true, expanding Medicaid could seriously hurt state budgets forced to absorb healthcare costs of new residents. Fear of these costs has been an argument against expanding Medicaid.
Since only 25 states expanded Medicaid as of November with four others considering the move, the country's Medicaid expansion policy is heterogeneous, the Health Affairs researchers noted. This made conditions ripe for a migration study.
Researchers used data from the 1998-2012 Annual Supplements to the Current Population Survey and examined migration patterns of more than 62,000 low-income Americans between the ages of 19 and 64 in Arizona, Maine, Massachusetts and New York. These states "substantially expanded eligibility for subsidized health insurance in the past decade," the report noted. The control group included geographically and demographically similar states that hadn't expanded their health insurance programs.
In expansion and control groups, the study found no statistically significant post-expansion migration changes. Therefore, "migration should not be a major concern for states considering Medicaid expansions under the ACA," the study states.
These findings contrast with results of a November Bankrate survey of 1000 adults, which found 32 percent of low-income people would consider relocating for health insurance. But consideration doesn't always mean pulling up stakes, and if the Health Affairs study results are predictive, few will do so.
- here's the Health Affairs study abstract