Medicaid enrollment is declining. That's cause for celebration
For most Americans, the end of the COVID-19 public health emergency was a relief. But some progressive activists and politicians would seemingly prefer that the crisis -- and the gusher of federal spending it unleashed -- never end.
Democrats are telling everyone who will listen that the end of the pandemic-era de facto ban on disenrolling people from Medicaid will push millions of people into the ranks of the uninsured. But a return to Medicaid's pre-COVID eligibility rules is prudent -- not just for taxpayers but for former beneficiaries, who will in many cases be able to secure higher-quality coverage than they had during the pandemic.
Medicaid was designed to insure the truly destitute. During the pandemic, lawmakers wanted to ensure no one fell through the cracks. So the federal government promised states additional dollars if they kept people enrolled continuously, even if they would have been ineligible under normal circumstances.
The feds will slowly ratchet those extra dollars down through the end of this year. So states have several months to finish redetermining whether the people on their Medicaid rolls are actually eligible.
The Biden administration estimates that this redetermination process will boot 15 million people from the program. About 6.8 million will remain eligible -- they just need to sign up.
And if they don't find out that they've been disenrolled until after they need care, there’s a good chance they'll be able to secure coverage retroactively, for expenses incurred up to three months prior.
The other 8.2 million who exit will have plenty of options for coverage. The administration projects that 5 million will secure health insurance through other means, primarily employer-sponsored coverage. Some 2.7 million will qualify for subsidized coverage through Obamacare's exchanges. Sixty percent of this group will be eligible for zero-premium plans.
Moving from public coverage to private coverage is a victory not just for taxpayers but for beneficiaries. Private insurance is generally better than Medicaid. Physicians are generally less likely to accept Medicaid. So people covered by the public program may have to wait longer for an appointment -- or may not be able to see the doctor of their choice.
In other words, most of the people who leave Medicaid could end up better off than they were while on the program. And a sizable share of the "victims" of this redetermination process will be able to keep the benefits they had throughout the pandemic just by reapplying.
Those who wish to freeze Medicaid in its bloated state are blind to fiscal reality. Nationwide, Medicaid enrollment grew to nearly 95 million Americans during the pandemic. Spending on the program reached $734 billion in 2021, an increase of 9.2% over the previous year. The federal government projects that our annual Medicaid tab will pass $1 trillion by 2028.
Already, Medicaid is the second-largest category of spending for states, after education. If the program keeps growing, states will be forced to cut spending on other key priorities. And they can't count on increased funding from Washington to keep their Medicaid programs -- and budgets -- afloat.
A once-in-a-century pandemic does not justify a permanent expansion of Medicaid. Millions of Americans will lose their Medicaid coverage in the months to come. That's not cause for concern. It's something that will redound to their benefit -- and taxpayers' -- over the long term.Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is "False Premise, False Promise: The Disastrous Reality of Medicare for All."
This article originally appeared on Fort Myers News-Press: Medicaid enrollment is declining. That's cause for celebration
