In Denver, 2½ times as many people enrolled in the taxpayer-funded Medicaid program from October through the first quarter of 2014 as those who signed up for private insurance through the state exchange, state figures show.
And in Colorado and nationwide, Medicaid enrollments outpace private insurance registrants.
Colorado ranked 11th in the nation of states with the highest percentage of Medicaid enrollments compared with private insurance subscribers through marketplaces as of the end of February, a Denver Post analysis of federal numbers shows.
State Sen. Kent Lambert, a Colorado Springs Republican who serves on the Joint Budget Committee, said the Medicaid figures show that the Affordable Care Act was more about expanding government-funded health care than getting more people covered by private health insurance.
“It’s a huge burden on taxpayers,” Lambert said. “Colorado made a decision, the governor made a decision under Democratic leadership to expand the criteria for Medicaid to a much larger population, and the federal government also expanded Medicaid.”
But Susan Birch, executive director of the Colorado Department of Health Care Policy and Financing, said the Medicaid expansion will not impact the state budget but will help get costs under control.
“Taxpayers are paying for these people in emergency rooms and jails,” she said. “It’s far cheaper to coordinate care and keep asthma under control, keep diabetes from resulting in amputation.”
She said she was not surprised by the level of Medicaid sign-ups.
In Colorado, 158,521 people enrolled for Medicaid, while 118,628 signed up for private insurance at the state health insurance exchange, Connect for Health Colorado, the most recent federal and state figures show. Nationwide, 4.37 million people signed up for Medicaid, compared with 4.24 million people who signed up for private coverage through exchanges.
In Denver, more than 26,000 people qualified for Medicaid between October and the end of February. About 10,700 Denver residents bought coverage through the exchange through March 8, according to numbers compiled by Denver Health from state and exchange sources.
Through March, 29,000 people in Denver qualified for Medicaid, but March numbers were not available for Denver enrollments for private insurance through the exchange.
Dr. William Burman, executive director of Denver Health’s public health department, said additional Medicaid recipients allow medical providers to get paid to treat patients.
“What it provides is an opportunity to get reimbursed,” he said.
In Colorado, both the Affordable Care Act and state legislation are contributing to the increase in Medicaid enrollments.
In 2009, legislators expanded Medicaid and other coverage for poor Colorado residents, including providing coverage to children up to 250 percent of poverty and adults with children up to 100 percent of poverty. The Affordable Care Act made adults without children and others eligible for the program if they earn less than about 133 percent of poverty, which is about $15,000 a year.
Denver resident Patrick Jones tried to sign up for private health insurance through the state exchange after quitting his job to return to get more work training, but he said he was directed to Medicaid.
“I was shocked,” said the 27-year-old who left an Internet marketing job to learn programming through an online course. “I was ready to pay for insurance, and I was shocked when I was told you are going to receive Medicaid.”
But Jones is happy because he gets insurance coverage with no monthly premium at least until he starts a new job and gets employer coverage or makes too much to qualify for Medicaid.
“I get to pursue a career change and not have to spend $150 a month for insurance that I can use to pay rent and for classes,” he said.
The federal government agreed to pay for any ACA expansion of Medicaid through 2016, and after that the state’s share will expand gradually until states pay 10 percent by 2020.
In Colorado, estimates show the 2009 state expansion will increase Medicaid by 220,000 people over the next decade, and the ACA will bring nearly 60,000 more people into the program. The projected 10-year cost of all the expansion is $13 billion.
Even after 2016, the Medicaid expansion in Colorado won’t impact the state general fund budget because lawmakers decided to use a fee on hospital bed occupancy to pay the state share, Birch said.
“People are pleased because when we have so many uninsured, it ultimately impacts our state’s ability to get health care spending down,” Birch said, adding that medical providers won’t have to shift costs to insured patients to cover uninsured people. “This will translate into cheaper premiums for us.”
However, the state expects more people to apply for Medicaid because of the recent publicity and mandates surrounding the ACA, and the state will pay for any recipients who qualify for Medicaid but do not meet the standards of the federal expansion. The JBC figures estimate the state will spend about $4.5 million in general fund and $67 million in cash fund for the next fiscal year for additional Medicaid recipients not eligible under the ACA expansion, JBC figures show.
And for the ones covered by federal funds, Lambert said the federal government will just increase the federal debt to pay for the additional Medicaid recipients.
“There isn’t such a thing as magic money,” he said, pointing out that Colorado residents pay federal taxes, too. “It’s coming from some place. Colorado taxpayers are going to pay one way or another.”
This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.
Medicaid growth
These are the top 12 states for Medicaid enrollment growth from October to February as a percentage of enrollments in private insurance through health-insurance exchanges.
Washington 586%
Nevada 439%
Kentucky 404%
Maryland 272%
Oregon 269%
Rhode Island 239%
Minnesota 225%
Arkansas 209%
Iowa 188%
New Jersey 165%
Colorado 162%
West Virginia 156%
Source: U.S. Department of Health & Human Services