What Will Medicaid Look Like Under Obamacare?


A new study from the University of Michigan examines what the demographics of people with Medicaid coverage will look like after Obamacare’s optional expansion of the program. The findings are great news for government entitlement spending and the health of poor Americans who live lifestyles that could lead to future, costly illnesses — but that may be prevented through early medical treatment.

The report was accompanied by a graphic comparing the current 50-million person Medicaid pool against the expected 55-to-60 million person pool under the health law:

U Mich Medicaid

CREDIT: University of Michigan

As the infographic shows, the Medicaid expansion will make the program’s beneficiaries younger, less obese, and less likely to be suffering from depression. It will also bring in a substantial number of previously uninsured and childless younger men — which make sense, since most states’ current Medicaid eligibility rules only extend coverage to pregnant mothers, low-income parents, and the disabled. States that choose to expand Medicaid under the Affordable Care Act will be able to provide coverage for all adults living up to about 138 percent of the Federal Poverty Level (FPL).

Study authors expect the newly-insured population’s health demographics will ultimately bring down U.S. health care spending.

“Under the ACA, physicians can anticipate a potentially eligible Medicaid population with equal if not better current health status and lower prevalence of obesity and depression than current Medicaid beneficiaries,” wrote the researchers. “Federal Medicaid expenditures for newly covered beneficiaries therefore may not be as high as anticipated in the short term.” The authors also noted that doctors may be more willing to accept Medicaid patients under Obamacare knowing that the new patients won’t be substantially older, sicker, and more difficult to care for.

The proportion of beneficiaries who will be smokers or heavy drinkers will increase substantially under expansion. But if doctors treating these patients provide them with preventative care services — like smoking cessation advice, which has been shown to have a statistically significant effect on convincing people to stop smoking, and recommendations for healthier alcohol intake habits — those Americans may be less likely to develop chronic illnesses like diabetes and hypertension.

The researchers were careful to note that their study is based on the assumption that all 50 states expand Medicaid. Since only 24 states and the District of Columbia have actually chosen to do so — while 21 GOP-led states have flat-out refused expansion and another four states are still debating the issue — the new Medicaid population will likely be even healthier than what the researchers predict.

That’s because many of the states refusing expansion are among the poorest and most unhealthy in the country. While that may mean less federal spending on poor and sick people in the short term, it also means that sicker Americans will have to forgo crucial medical care and may end up getting even sicker, costing the government much more money once they become eligible for Medicare.