Affordable Care Act likely to create uncertainties in Medicaid enrollment, costs, and physician workforce needs
The expansion in 2014 of Medicaid to millions of additional United States citizens and residents by the Affordable Care Act of 2010 (ACA) will bring major uncertainties in enrollment, costs, and the need for additional physicians, concludes a new study.
The ACA will expand Medicaid eligibility to all U.S. citizens and qualified residents with incomes below 138 percent of the Federal poverty level in order to increase access to care. Estimates of new Medicaid enrollment in 2019 are 16 million and 18 million individuals, by the Congressional Budget Office and the Centers for Medicare & Medicaid Services, respectively.
The researchers developed a simulation model to identify for policymakers the factors that most strongly influence enrollment, costs, and provider workforce needs under the new law and to provide a range of estimates of these values as of 2019 under a variety of plausible conditions. Their model found that the number of new enrollees in Medicaid could vary by more than 10 million individuals, from a base case estimate of 13.4 million individuals and a range of 8.5 million to 22.4 million new participants. This would result in additional Federal spending for new Medicaid enrollees from $34 billion to $98 billion annually, and a need for 4,500–12,100 new physicians to care for the new Medicaid participants. The largest group of new enrollees would be newly eligible uninsured adults, estimated to range from 4.6 million to 11.3 million new enrollees.
For their simulation, the researchers used data from two different surveys conducted by the U.S. Census Bureau, the 2009 Current Population Survey and the 2008 Survey of Income and Program Participation. The study was funded in part by the Agency for Healthcare Research and Quality (HS19754).
More details are in "Policy makers should prepare for major uncertainties in Medicaid enrollment, costs, and needs for physicians under health reform," by Benjamin D. Sommers, M.D., Ph.D., Katherine Swartz, Ph.D., and Arnold Epstein, M.D., M.S., in the November 2011 Health Affairs 30(11), pp. 2186-2193.
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