States Medicaid Experience

“Medicaid was designed as a safety net for our nation’s poorest and sickest people,” Rep. Joe Pitts, R-PA, chairman of the Energy and Commerce Health Subcommittee, said during a hearing on March 18, 2013. “States are already struggling to serve this core population.

“Increasingly, doctors simply can’t afford to treat Medicaid patients. Is it fair that the president’s health care law will force millions of disabled and sick Americans to compete with able-bodied 25-year-olds for appointments with those doctors who will still see them?”

Medicaid Expansion
Medicaid Expansion

Kasich’s (Ohio) Medicaid expansion has cost taxpayers $7 billion

Ohio’s Obamacare expansion has already run $3.1 billion over budget and is on track to run nearly $8 billion over budget by the end of next year,” Jonathan Ingram, research director at the free-market Foundation for Government Accountability, told “Finding the funding to pay for those overruns will mean fewer resources for education, public safety, and care for the most vulnerable,” Ingram said. Obamacare expansion spending already dwarfs the monthly budgets of many state programs; disbursements for the Ohio Department of Rehabilitation and Corrections, for example, totaled $100 million in February. Ingram noted that changes to the state’s Medicaid eligibility determination process will soon bump thousands of disabled Ohioans from the Medicaid rolls, while 670,000 able-bodied, working-age adults are enrolled under Kasich’s Obamacare expansion.

Update: Ohio’s Obamacare expansion: Ohio Medicaid expansion costs sailed farther past Gov. John Kasich’s projections in March, as total spending on the program topped the $7.5 billion mark

Expansion cost $411 million last month, making March the most expensive month yet. For the past six months, expansion costs reported by the Ohio Department of Medicaid averaged $394 million — dwarfing other state programs.
Kasich’s budget office reported $312 million in primary and secondary education expenditures, $186 million in higher education expenditures, and $170 million in justice and public protection expenditures in March. The governor predicted that adding working-age adults with no kids and no disabilities to the Medicaid rolls under the 2010 federal health law would cost $14 billion from 2014-20. Actual spending puts Kasich’s Obamacare expansion on track to cost $28.5 billion by 2020.

arrowThe following links will provide more information based on actual experience with Medicaid expansion:


  • WSJ: ObamaCare’s Medicaid expansion hasn’t benefited nonprofit hospitals in those states as expected, according to a new report by Moody’s Investors Service.
  • American College of Emergency Physicians: A recent survey of ER physicians shows that emergency department use was on the rise, despite the goal of Medicaid expansion to prevent that.
  • Pittsburgh Post-Gazette: After Pennsylvania expanded Medicaid last year, uncompensated care for the state’s 171 acute care hospitals increased by $22 million.
  • MinnPost: Unpaid hospital bills have gone up by $80 million per year, after Medicaid expansion.
  • Moody’s: Hospitals in Medicaid expansion states were supposed to benefit from fewer unpaid bills and more paying customers, but that hasn’t generally translated into better margins or cash flow. In the fourth quarter of 2014, hospitals in non-expansion states actually improved their operating margins by 1.3 percentage points, while those in expansion states saw an improvement of only about 0.9 percentage points,
  • UC Davis: Medicaid expansion states will still feel DSH cut pain (and DSH cuts don’t start until 2018).
  • Arkansas City Wire: Arkansas Children’s Hospital and UAMS found they were being paid only 82% of costs and lost $83 million treating Medicaid patients. Those payments are paid quarterly, but it’s often six months before the hospital sees the money.
  • Louisville Courier-Journal: Kentucky hospitals say ObamaCare is forcing them to make cuts and layoffs; they say they’ll lose money under the Affordable Care Act than they gain in revenue from expanded coverage. This, after they had the second-largest drop in the uninsured in the country.
  • Kaiser Family Foundation: The headlines are about patient visits in comparing expansion states to non-expansion states, but there is a different story when it comes to revenues. the hospitals actually have better revenues in the non-expansion states. Expansion changed the payer mix, more Medicaid, but less income from commercial and self-pay which pay better than Medicaid as we well know. Expansion probably, though the paper does not examine, caused some erosion in employer sponsored as well.
  • Washington Post: Economy is boosting hospital revenue in non-expansion states.
  • Becker’s Hospital Review: Financial gains from ACA slowing; will affect smaller hospitals.
  • Modern Healthcare: Virginia’s hospitals improving by 37%; for LifePoint, revenue at its six VA hospitals beat its nine KY hospitals in a MedEx state.
  • Charleston Daily Gazette: Medicaid hospitals still facing big losses after expansion.
  • KALB: Even with MedEx, Louisiana’s hospitals will still close.
  • Arkansas Business: UAMS, AR’s largest hospital, still facing huge losses after Medicaid expansion.


  • Modern Healthcare: Modern Healthcare notes that similar cost-sharing demonstrations in Arkansas, Indiana, Iowa, and Michigan have actually netted little revenue thus far.
  • Arkansas Online: The Arkansas Private Option reports that more than 250,000 Arkansas have enrolled in that state’s Medicaid expansion … more than state officials even thought were eligible for the program.
  • Watchdog: Ohio’s Medicaid expansion now $1 billion over budget..
  • Arkansas Online: The Private Option has now thrown off 48,000 enrollees due to unverified eligibility.
  • Arkansas Business: Arkansas’ Private Option benefits AR’s largest insurers.
  • Bismarck Tribune: North Dakota’s Medicaid expansion now have cost overruns of more than $5 million.
  • AP: 70% of Arkansas parolees have now signed up for Medicaid expansion.
  • McKnight’s: New Hampshire cutting nursing home funding because of Medicaid expansion (while neighbor Maine has increased nursing home funding two years in a row).
  • Benefit Revolution: Nevada’s Medicaid expansion has led to double the enrollment and two-month wait times in Reno.
  • Associated Press: New Mexico legislators worry about rising Medicaid expansion costs.
  • Arkansas Times: Asa proposing $400M in cuts to truly needy to pay for PO.
  • KTVA: Alaska DHSS proposing $90M in Medicaid cuts after expanding Medicaid; admits it only “gains” $10M with Medicaid expansion.
  • Healthcare Dive: Kentucky’s Medicaid expansion not sustainable, official claims.
  • Albuquerque Journal: After experiencing record ObamaCare Medicaid expansion enrollment, NM is looking at provider rate cuts and other measures to make up a nearly half-a-billion dollar shortfall. By July 2017, NM now projects that half of its state population will be on Medicaid.
  • KPAX (Montana): Montana MedEx has signed up 36k people as of March 10, 2016 — more than the Bullock administration thought would sign up through mid-2017.
  • Lexington Herald-Leader: Kentucky cutting services for brain injury patients after MedEx.
  • WV Public Radio: West Virginia’s MedEx is straining the budget and contributing to the deficit.


  • U.S. News & World Report: Jails and prisons across the country are “aggressively enrolling” inmates in ObamaCare’s Medicaid expansion, according to U.S. News & World Report. To pay for ObamaCare, seniors’ Medicare will sustain cuts of $716 billion.
  • Politico: Medicaid enrollment under Obamacare is skyrocketing past expectations, giving some GOP governors who oppose the program’s expansion under the health law an “I told you so” moment.
  • Forbes: Reported that Medicaid enrollees receive very little benefit from each dollar spent on Medicaid. The absolute minimum enrollees receive is 15 cents of benefit per dollar spent. The authors’ best guess is that enrollees receive somewhere around 20-40 cents of benefit per dollar spent. The maximum is 90 cents–that is, no matter how the authors sliced the data, Medicaid’s costs exceed the benefits to enrollees. If the government just gave enrollees the money, Medicaid is such a bad deal that enrollees would not buy Medicaid coverage with it.
  • Forbes: Obama Administration admits that Medicaid expansion is costing way more than expected.
  • NYT: Half of doctors listed as serving Medicaid patients are unavailable.
  • Watchdog/Mercatus: MedEx steals from other priorities.
  • Governing: Having affordable health insurance can improve people’s health, but only if a state’s health-care system actually works. The new study present results from a small project in Ohio that made extensive use of electronic health records to allow for information sharing, along with team-based primary care and nurses acting as coordinators across the system.
  • KHN: California Medicaid patients with cancer fare far worse.
  • Breitbart/Heritage: Nearly all of the coverage gains from the ACA were from Medicaid expansion.
  • Benefits Pro: Private insurers win big from Medicaid expansion.
  • SF Chronicle: CT hospitals sue over “unconstitutional” provider tax that CT used to pay state’s share of MedEx costs.


  • American Action Forum: Medicaid expansion will not stimulate the economy or create jobs.
  • Modern Healthcare: Economists find no evidence that Medicaid expansion adds healthcare jobs.
  • NEJM: Harvard economists debunk the myth that expansion will create more jobs.
  • Valuewalk: States that have expanded Medicaid are experiencing slower job and economic growth
  • WDRB: KY Gov. Steve Beshear claimed MedEx created 12,000 jobs, but that hasn’t materialized. As part of that figure, Beshear claimed that hospital jobs would grow by more than 3,000 — but in reality, hospitals jobs declined by 2,660.