di id i imedicaid expansion in sc

tonight’s talktonight s talk Background Politics of expansion Impact on People Impact on Business Impact on Business Impact on the Economy Final Thoughts

expanding coverage under acaexpanding coverage under aca

Medicaid Expansion:Medicaid Expansion: Will cover 250,000 uninsured in SC By 2014 states can extend Medicaid eligibility to all g

legal residents up to 138% of poverty and under 65 years old

138% FPL is about $16,000 for individual and 138% FPL is about $16,000 for individual and $32,500 for family of 4

From 2014-2016 the federal government will cover 100% of state costs100% of state costs

who will benefit?who will benefit?

who’s participating?who s participating?• 25 states and DC

moving toward moving toward Expansion

• 4 considering • 21 states not

expanding• Many southern

states including South CarolinaSouth Carolina

• Most also not participating in a state-run state run insurance marketplace

how much will the medicaid expansion cost sc?how much will the medicaid expansion cost sc?

Year State State Administrative

FederalCost

2014 0 $19m $706m

2015 0 $19 $1 7b2015 0 $19m $1.7b

2016 0 $18m $1.8b

20 $ 6 $ 8 $ 8b2017 $46m $18m $1.8b

2018 $107m $19m $1.8b

2019 $132m $19m $1.9b

2020 $180m $20m $1.9b

Totals $465m $132m $11.7b

the new coverage gapthe new coverage gap

Families of four making as much as $94,000 a g $ ,year will receive subsidies to help buy health insurance200 000 i d S th C li i ill 200,000 poor, uninsured South Carolinians will receive no coverage assistance through ACA if SC opts out of the Medicaid expansion Parents in low income families of four making between

$11,800 and $23,500 a year Childless adults making under $11,000 a yearChildless adults making under $11,000 a year 13,000 veterans and their spouses 51,500 uninsured citizens age 50-64

statewide impactstatewide impact

$2,601,505,270 TOTAL CUTS WITH OR WITHOUT MEDICAID EXPANSION FROM 2014-2020.

$11,706,700,000 The total amount our state would receive in federal funding from 2014 to 2020 if South Carolina decides to expand Medicaid.

impact on community health centersimpact on community health centers

h l hSC community health centers missed out on $25 million in revenue in 2014 because SC revenue in 2014 because SC rejected Medicaid Expansion.

The George Washington University, “Assessing the Potential Impact of the ACA on Uninsured Community

H lth C t P ti t ” O t b 2013Health Center Patients, October 2013

impact on state and local governmentimpact on state and local government

“W ti t th t 3 6 illi f l “We estimate that 3.6 million fewer people would be insured, federal transfer payments to those states could fall by $8.4payments to those states could fall by $8.4billion, and state spending on uncompensated care could increase by $1 billion in 2016… In terms of coverage,cost, and federal payments, states woulddo best to expand Medicaid ”do best to expand Medicaid.

RAND Corporation, “For States That Opt Out Of Medicaid E i 3 6 Milli F I d A d $8 4 BilliExpansion: 3.6 Million Fewer Insured And $8.4 Billion

Less In Federal Payments,” June 2013

impact on businessimpact on business

“ ll b“Pressures will be greatest in states that opt out of Medicaid expansion but have a relatively expansion, but have a relatively high proportion of uninsured residents”residents

Moody's, "Reduction of Medicaid & Medicare Disproportionate Share Hospital Payments a Looming Challenge for States and Hospitals ” March 14 2013Challenge for States and Hospitals. March 14, 2013

impact on businessimpact on business

“Hospitals and healthcare systemsHospitals and healthcare systemsoperating in states that do not expandMedicaid coverage under the ACA will faceggreater financial challenges and rating pressure compared to hospitals and health

t i t t th t d M di idsystems in states that expand Medicaidcoverage”

Fitch Ratings “Adverse Expansion: Hospitals, States, and Medicaid”

October 28, 2013

impact on businessimpact on business

“P i i ld b “Premium increases would be even higher among those states that do not expand Medicaid. Premium increases pwould be borne by nonsubsidized purchasers and by the federal government Exchange premiums also government… Exchange premiums also may increase…” American Academy of Actuaries, “Implications of Medicaid

Expansion Decisions on Private Coverage” September 2012

impact on businessimpact on business

h d d l kThe average individual market and exchange premium will be $120 higher annually if SC does $120 higher annually if SC does not expand Medicaid.

The Society of Actuaries, “Exposure Draft: Cost of the y f , p f fFuture Newly Insured under the Affordable Care Act”

December 2012

Not expanding Medicaid could expose SC employers to $30 to $45 million in annual p y $ $ACA shared responsibility payments.

Jackson Hewitt, “State Medicaid Choices and The Hidden Surprises for Employers: Without Medicaid Expansion,

Employers Face Higher Tax PenaltiesU d ACA” J 2014Under ACA” January 2014

economic impact in sceconomic impact in sc

key messages on medicaid expansionkey messages on medicaid expansion

If we don’t act now and expand Medicaid, South p ,Carolinians‘ dollars will be sent to other states that are expanding Medicaid. This plan keeps your dollars at home.

An additional 250,000 uninsured South Carolinians will gain insurance coverage under this expansion,

i th b d l h it leasing the burden on rural hospitals.

Refusing Medicaid expansion means that South Carolina businesses and insured accept a higher a o a bu a d u d a p a gburden of cost for caring for the uninsured.

Medicaid expansion will help pay for itself.

despite concerns these facts remain:despite concerns, these facts remain: SC hospitals will continue to

care for uninsured patients; care for uninsured patients; federal law requires them to do so.

The cost of that care must The cost of that care must be paid by someone, and there are two options: We can let the other We can let the other

states help pay 90% of it (they are offering to do so through Medicaid), or

We can absorb 100% of the costs within our borders.

Which strategy will make SC more competitive?