Medicaid enrollment is health law's bright spot

Kelly Kennedy | USA TODAY

WASHINGTON — Amid the low enrollment numbers for health insurance via the HealthCare.gov website, the Obama administration found one bright spot: Medicaid.

Almost 400,000 people have learned they are eligible to enroll in the states' Medicaid programs, and the numbers are high even in Republican-dominated states that have chosen not to expand the program.

President Obama highlighted the Medicaid enrollment numbers Thursday, even as he took blame for the poor early performance of the health exchanges and for misleading some Americans that their health care policies would not change. Obama said the 396,000 new enrollees for Medicaid are something "that's been less reported on, but it shouldn't be.

"Americans who are having a difficult time, who are poor, many of them working, may have a disability; they're Americans like everybody else, and the fact that they are now able to get insurance is going to be critically important."

About 106,000 Americans selected private health care plans in October, the first month the state and federal health exchanges were open — one-fourth the number who were determined eligible for Medicaid.

That's a boon for needy Americans seeking help for their health care, but an early sign the Affordable Care Act is so far more of a social welfare program than a way to get people to buy their own health insurance. Still, health experts say, their ability to get insurance could drive down everyone else's costs.

The expansion included in the law allows states to provide Medicaid coverage for adults who make less than 138% of the poverty level for three years with the federal government paying all of the extra costs. After three years, the federal share will remain 90% and the states will pay 10% of the expansion costs. Twenty-five states have so far declined to expand Medicaid, citing higher costs or opposition to the Affordable Care Act.

North Carolina, which chose not to expand Medicaid, determined 7,404 people were eligible for Medicaid, while about 1,600 have chosen an insurance plan through the federal exchange.

"Even in a state where we didn't expand, more people signed up for Medicaid," said Don Taylor, associate professor of public policy at Duke University's Sanford School of Public Policy. But he said that "might be expected" when the coverage is free.

Until the exchanges are working properly, it's hard to tell how higher Medicaid enrollments will mix with the private insurance market or if Medicaid will somehow overwhelm the health care system with charity cases, Taylor said.

"It's a legitimate worry, but the only way to really know is to live through the next few months," he said.

There are several reasons for the growth in Medicaid patients, said Sara Dash, a researcher at Georgetown University's Health Policy Institute. They include:

• The "welcome mat" effect comes when people already know Medicaid is available, but they don't know they're eligible until they visit an exchange site and enter their information.

• The Affordable Care Act required the states to streamline the enrollment process.

• It's just easier to sign up for Medicaid because beneficiaries don't have to compare plans and pay a fee.

"And when the federal website's not working, that's kind of obviously not easy," Dash said. "But I think there are probably millions of people waiting in the wings for the private plans, even in the states where the websites are working fine."

Ultimately, she said, the more people who sign up for Medicaid, the better because recent research shows people who receive preventive health care, as well as those who learn to control issues like diabetes or heart disease, cost the health care system less.

"It means you have a whole lot of low-income people who didn't have insurance before who have it now," she said.

In Washington state, which expanded its Medicaid program, 48,196 were determined eligible for Medicaid or the Children's Health Insurance Program, federal records show.

State officials expected higher Medicaid enrollment because a lot of people were already eligible for the program and just didn't know it, said Michael Marchand, spokesman for Washington's health exchange.

For the private plans, 9,000 people have initiated payment, Marchand said, and 40,000 have chosen a plan but haven't chosen a payment option yet.

In California, officials expect 1 million people to enroll in the state's Medicaid program. So far, 72,000 people have qualified for Medicaid in California, said Norman Williams, deputy director for public affairs at the California Department of Health Care Services.

But he sees it as a sign of the future for the country, as well. In the first 12 days of November, California saw its enrollment for private plans match the entire month of October, Williams said. About 2,000 people per day enrolled, for a total of nearly 60,000.

"The relative success story in California will be important to show the system is working," he said.

Obama traveled Thursday to Ohio, where Republican Gov. John Kasich recently engineered expanding Medicaid by bypassing the GOP-led state Legislature and using an obscure state board to approve the acceptance and spending of the federal money to boost the program.

In the first month of the exchanges, 1,150 Ohioans used the health care exchange to select private insurance, while 7,535 were found eligible for Medicaid.

Cathy Levine, executive director of UHCAN (Universal Health Care Action Network) Ohio, a health care advocacy group, said people are "intrigued," but that they don't understand that they're eligible.

"Most of the people who look for affordable coverage assume they're not eligible for Medicaid," she said. "They're working two and three jobs, and they think Medicaid is for people on food stamps."

She said people have told her they're relieved — and with 275,000 people newly eligible for Medicaid, she's hearing it a lot.

As for the private plans, "A lot of people are shopping around," she said. "We think as we get closer to December 15, the activity's going to pick up."