View Research by Author - Emily Lawton

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This report presents data on changes in Medicaid's enrollment and spending between federal fiscal year 2007 and federal fiscal year 2010, a period which includes the worst economic downturn in the United States since the Great Depression of the 1930s. The paper also examines what factors drove Medicaid spending over the period, and concludes that overall spending growth from 2007 to 2010 was driven largely by the enrollment growth that resulted from many people losing jobs and income during the recession. However, on a per enrollee basis, Medicaid spending has grown more slowly than other sectors of the health system.

The increase in undocumented immigration between 1999 and 2007 contributed to an increase in the number of uninsured people in the United States. During this period, the number of undocumented immigrants increased from an estimated 8.5 million to 11.8 million, leading to an estimated additional 1.8 million uninsured. Undocumented immigrants accounted for one in seven of the uninsured in 2007, up from one in eight in 1999. Since undocumented immigrants will not be eligible for public insurance or private coverage obtained through exchanges under the Affordable Care Act, they will eventually constitute a larger percentage of the uninsured population.

This latest edition of our annual chartbook series for New York State features detailed information about differences in insurance coverage and uninsurance around New York State and within New York City. Overall, 12.9 percent of New Yorkers (889,000 total) under the age of 65 lacked health insurance in 2009, unchanged from the previous year despite an ongoing recession. Data for 14 separate regions across New York State, including the five boroughs of New York City and for 55 separate neighborhoods within the city itself show enormous variation in health insurance coverage across the state.

The House Republican Budget Plan would make major changes to the structure of the Medicaid program. In this brief we estimate reductions in federal Medicaid spending due to both the repeal of the Affordable Care Act on Medicaid and the block grant provisions themselves. We find that the House Budget Plan would reduce federal spending by $1.4 billion between 2012 and 2021, a cut of 34 percent relative to current law. The impacts are greatest in states that would have the largest coverage expansions due to the Affordable Care Act. We also estimate the loss of Medicaid coverage that would be likely under different assumptions of states’ success in constraining spending. Finally we estimate the increase in state expenditures that would be necessary to maintain their current programs even assuming some cost containment success.

This report examines Medicaid spending growth nationally during the last decade, with a focus on growth during the recession of 2007 to 2009. The recession-driven enrollment growth in recent years drove program spending to increase faster than national health spending overall, but on a per enrollee basis the growth in Medicaid spending has remained lower than the rise in private insurance premiums and overall national health expenditures. The recession-driven increase in Medicaid enrollment has been the primary cause of the increase in overall Medicaid spending.

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