Out-of-Pocket Health Care Costs Could be Fifteen-Times Lower for Near-Poverty Utahns Under Full Medicaid Expansion
As the state hears public comment on the "Fallback Plan" waiver,
a new report from UHPP demonstrates the need for full expansion 
October 10, 2019

Stacy Stanford

SALT LAKE— A new report from Utah Health Policy Project analyzes out-of-pocket costs on the healthcare.gov Marketplace for low-income Utahns in the expansion population (100-138% FPL), and compares those with the out-of-pocket costs found in Medicaid. The Marketplace findings show a staggering burden for individuals closest to the poverty line, particularly for those with "high usage" treating chronic physical and mental illness. When compared to Medicaid, there is a dramatic difference in cost, with Marketplace enrollees expected to pay up to fifteen-times more out-of-pocket per year. 
Utah has long resisted full Medicaid expansion with the arguments that the state cannot afford it, while low-income Utahns can afford the cost sharing required in the Marketplace. 

This position relies on the insistence that there is highly-subsidized “platinum-level” coverage available on the Marketplace for people above the poverty line. This report illustrates how that claim quickly loses steam once you dig deeper into the options available and examine the out-of-pocket costs facing the lowest-income enrollees. 

This look at the importance of the low price of Medicaid comes just as the Department of Health is requesting added cost sharing on new Medicaid expansion enrollees. These added premiums and increased penalties for non-emergent ER usage would be an unnecessary step backward, and will keep people from the care they need.

Advocates for full Medicaid expansion have spent years arguing that access to Marketplace is not enough for people closest to the poverty line, and this analysis illustrates just how vital Medicaid is for the vulnerable Utahns in the expansion population.
The full report is available here: UHPP Out-of-Pocket Cost Analysis
with a one-page summary found HERE
as well as a one-page summary of the new cost sharing requirements under the "Fallback Plan" waiver available HERE
"It is clear that our neighbors near the poverty level are facing unbearable out-of-pocket health care costs, especially if they are struggling with physical or mental health issues," said Stacy Stanford, health policy analyst at Utah Health Policy Project. "Fully expanding Medicaid would ease that burden and allow them to take care of their health, without sacrificing groceries or rent."
The state will hold two public hearings to discuss the amendment and take public comment.
The second public hearing will be held  TODAY Thursday, October 10, 2019 from 2:00-4:00 p.m. , as part of the Medical Care Advisory Committee (MCAC). The meeting will be held in room 125 at the Cannon Health Building, 288 N 1460 W, Salt Lake City, Utah. 

The proposed application is available online at  https://medicaid.utah.gov/1115-waiver .

A brief rundown on the fallback plan is from UHPP is available HERE

The public may comment on the proposed application request during the 30-day public comment period  from September 27, 2019 through October 27, 2019 .
For more information contact:

Stacy Stanford, Policy Analyst
Utah Health Policy Project

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