Ronald Reagan once said that Americans "should measure welfare's success by how many people leave welfare, not by how many are added." Unfortunately, the Affordable Care Act (ACA) has taken us in the opposite direction. Even in Missouri—which prudently chose not to expand Medicaid under the ACA—the law is swelling the state’s welfare rolls, as reported by the Jefferson City News Tribune:
The number of Medicaid cases, including youth in the Children’s Health Insurance Program (CHIP), hit a high point in May with more than 918,000 cases. Since January, the cases have increased by more than 55,000 due to various factors, including the implementation of a new enrollment system and policies in the Affordable Care Act, said Brian Kinkade, director of the department of social services.
Cases hit a low in May of last year with approximately 819,000 enrolled, which Kinkade credited to the Affordable Care Act taking effect in January. They have since steadily increased, but with a more noticeable jump this year.
Missouri’s population is just over 6 million, so having over 900,000 enrollees means that about one in seven Missourians is now in the state's Medicaid program. Part of the year-over-year growth here is attributable to the department fixing a host of technology problems, about which I've written before.
But much of the topline enrollment growth is connected to the "woodwork effect" of the ACA. The woodwork effect describes what happens when individuals currently eligible for Medicaid but not enrolled become enrolled, thanks to other enrollment drives pushed under the law. Enrollees "come out of the woodwork" and join the program who, but for the ACA, would not have. In fact, much of the cost of the ACA comes from this woodwork population, who on a per-beneficiary basis are considerably more expensive to states than the expanded population. Policymakers should keep in mind that ACA supporters often omit those expanded costs when talking about the law, perhaps because it dispels the illusion of "savings" they regularly tout.
The latest numbers from the Medicaid program serve as yet another reminder that a Medicaid expansion under the ACA is precisely the wrong course for Missourians and for Missouri's budget. Our state leaders must remember that growing welfare rolls are not a mark of success, but of policy failure.