Even as many states rushed to expand Medicaid coverage to able-bodied adults under Obamacare, nearly a quarter million of the most vulnerable beneficiaries languish on waiting lists for special services and almost 22,000 have died, a new study shows.
The Foundation for Government Accountability (FGA) a free market think tank based in Florida, found that more than 650,000 Medicaid recipients in 38 states are on waiting lists for home- and community-based services to treat patients with spinal cord injuries, traumatic brain damage, developmental deficiencies, and other conditions.
That includes 247,295 people in states that accepted federal funds to expand coverage to the working poor, whose incomes previously made them ineligible for the program originally designed for the disabled, children and elderly.
The report identified 21,904 people in 13 expansion states who died before receiving those specialized services after Obamacare took effect — even as healthier adults got taxpayer-funded insurance coverage.
“They’re working-age, able-bodied adults,” said the report’s author, Nicholas Horton. “Every dollar spent on that population is a dollar that can’t be spent on people on waiting lists.”
The report points to Skylar Overman, a 12-year-old Arkansas girl who spent more than a decade on the state’s Medicaid waiting list for home health care services. While she and her family waited for services to help treat a rare neurological condition called schizencephaly, 300,000 able-bodied adults in the state got Medicaid coverage.
The Affordable Care Act promised billions of dollars to the states to expand Medicaid. Beginning in 2014, the federal government covered 100 percent of the expansion costs. Gradually, states kick in more, settling in 2020 at a maximum of 10 percent of the costs.
Although the Supreme Court ruled that the federal government could not compel states to expand, as Congress originally intended, many states jumped at the chance to pull down hundreds of millions and even billions of dollars from the federal treasury.
The result, according to the FGA study, was a rapid increase in able-bodied adults covered by the program. In 2013, the year before expansion took effect, Medicaid spent $67 billion nationwide on able-bodied adults. That total ballooned to $158 billion this year — with the expansion population accounting for 42 percent of the total.
[lz_table title=”Dying While Waiting” source=”Foundation for Government Accountability”]Waiting lists for special services
Louisiana,73 929,5 534
Maryland,36 156,8 495
Michigan,3 311,1 970
New Mexico,5 401,2 031
West Virginia,1 540,1 093
*People on waiting lists who have died since Obamacare
The 17.5 million able-bodied adults covered by the expansion now exceed the 10.7 million disabled recipients.
Horton, research director at the think tank, argued that the expansion caused states to lose sight of the program’s original mission.
“You need to take care of the truly needy first … That’s why the safety net exists,” he said.
The states that did not expand Medicaid are not off the hook, either, Horton said. He said those states by and large also have waiting lists for community- and home-based services.
“Non-expanding states are guilty of this, too,” he said.
Horton said states thinking of expanding should carefully consider whether that is the best strategy for focusing limited resources on the most needy. Horton’s report points to Louisiana, where the former Republican governor, Bobby Jindal, resisted Medicaid expansion.
When Democrat John Bel Edwards succeeded Jindal, he expanded the program in 2016 amid projections that 302,000 additional able-bodied adults would enroll. Instead, 332,000 signed up the first five months. As of December, there were more than 451,000.
Horton said states thinking of expanding should carefully consider whether that is the best strategy for focusing limited resources on the most needy.
Costs have skyrocketed, too. Actual costs in the first year, about $2.5 billion, more than doubled the $1.1 billion cost projection.
While able-bodied adults were reaping those billions of dollars in benefits, however, the report indicates that 5,534 special-needs residents died while on waiting lists for additional services. The study indicates that the average wait for the state’s New Opportunities program for people who have developmental disabilities is 2,377 days — more than six and a half years.
The report offers three recommendations:
- Wind down Medicaid expansions through enrollment freezes. The report projects that taxpayer savings, if every state took that step, would be $581 billion over 10 years. That is money that could be focused on vulnerable people on waiting lists.
- Pursue work requirements for able-bodied adult Medicaid recipients.
- Aggressively identify and eliminate fraud.
Horton rejected arguments of expansion supporters that federal investment that comes with increasing enrollees spurs economic growth. The federal funds by and large are borrowed, he said, and discourage work.
“It’s being spent to put people on welfare or pay them not to work,” he said.