Michigan lawmakers are currently deciding whether to expand the state's Medicaid program to cover people newly eligible for federal Medicaid subsidies under the Affordable Care Act of 2010, commonly known as "Obamacare." A target population for Medicaid subsidies are the uninsured and those with incomes between 100 and 138 percent of the federal poverty level. The authors estimate that in 2014, approximately 177,000 uninsured Michiganders will fall into this category. Assuming 70 percent sign up for Medicaid, the authors estimate the additional taxpayer cost will be $475 million to state taxpayers, and $7 billion to federal taxpayers.
The study considers several factors, including potential enrollees that are not considered in typical enrollment projections: uninsured people who are already eligible for Medicaid but have not yet enrolled, low-income, privately insured individuals who would switch to Medicaid, and childless adults and others who live below the poverty line and who would now qualify based on the broader definitions of the expansion.
The study determines that a Medicaid expansion would likely shift many insurance costs to state taxpayers, while other studies have found that as many as 50 percent or 60 percent of new enrollees following Medicaid expansions dropped existing private insurance to do so. Further, both local and federal studies have indicated that Medicaid often delivers substandard health outcomes and access to medical services. Therefore, lawmakers should think twice before widening the program's scope.