Rand: Newly insured will stress state budgets

The percentage of state populations with healthcare coverage will increase, but the percentage of employees offered insurance will not change substantially, and a small number of employees in firms with fewer than 100 employees in 2016 will obtain employer-sponsored insurance through state insurance exchanges, according to research from Rand Health.

Rand researchers estimated insurance coverage in five states--California, Connecticut, Illinois, Montana and Texas--using a microsimulation model Rand developed for the COMPARE (Comprehensive Assessment of Reform Efforts) initiative.

Results were estimated each year from 2011 to 2020 with specific data for 2016, the year in which all of the provisions in the Patient Protection & Affordable Care Act (PPACA) related to coverage expansion will be fully implemented.

“Substantial numbers of the nonelderly will choose to buy coverage through exchanges” the research found. “In most case, the majority of new Medicaid enrollees will be newly eligible, but increased enrollment of those previously eligible will cost the states because the federal government heavily subsidizes newly eligible enrollees,” the organization estimated. For example, the increase in the population of the newly insured in 2016, by state, will be 6 million in California, 170,000 in Connecticut, 1.3 million in Illinois, 125,000 in Montana and 5 million in Texas.

Total state government healthcare spending will increase in four of the five states examined, said Rand, a Santa Monica, Calif.-based nonprofit research organization. The percentage change in cumulative state healthcare spending from 2011 to 2020 is a 7 percent increase in California, 10 percent in Illinois, 3 percent in Montana and 10 percent in Texas. Spending will decrease in Connecticut by a projected 10 percent because some low-income individuals previously covered under the state insurance plan will now be covered under Medicaid, and the federal government will pay a large portion of their costs.

Additional state government healthcare spending per newly insured person in 2016 will be $333 for California, $540 for Illinois, $83 for Montana and $120 in Texas.

“The projections ... are all relative to what would be the case in the absence of the PPACA,” the organization concluded.

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