Sebelius predicts further Medicaid expansion under ACA

HHS Secretary says additional states will recognize the financial benefits of making Medicaid more accessible to their residents.

The number of states choosing to expand Medicaid eligibility under the Affordable Care Act (ACA) will almost certainly increase in the coming years, and the growth will transcend partisan politics, U.S. Health and Human Services Secretary Kathleen Sebelius, told Medical Economics.

Speaking at a February 3 news conference in Cleveland, Ohio, Sebelius noted that governors of 31 states, including 11 Republicans, have opted in to Medicaid expansion, and HHS is “in conversation” with others. The Medicaid program is jointly administered by the federal government and the individual states.  

“We’re encouraged by the number of governors who have stepped up,” she said, adding that more states are coming to see they can gain financially from expanding access to Medicaid. Earlier in the day she spoke in Kansas City, Missouri, a state which she says is losing $5 million per day by not broadening access to Medicaid for its residents.

Among the provisions of the ACA was a mandate for states to increase expand Medicaid eligibility for families with incomes up to 138% of the federal poverty level. The law included federal funding to pay the entire costs of the increased coverage for 3 years, and 90% thereafter. In 2012, the U.S. Supreme Court ruled that states could decide for themselves whether to expand Medicaid eligibility for their residents.

Sebelius’ news conference was part of an ongoing HHS campaign to promote enrollment through the federal and state health insurance exchanges created as part of the ACA. An HHS spokesman said Sebelius has visited more than 18 cities in recent months, focusing on those with large uninsured populations and where the federal government, rather than the state, has been operating the exchange. The open enrollment period for 2014 ends March 31.

In response to a question regarding the demographics of people who have signed up for health insurance so far, Sebelius said that about 75% of the three million new enrollees are under the age of 35. She also noted that when Massachusetts passed its law expanding health insurance coverage for residents, young and healthy residents were among the last to enroll before its deadline. 


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