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Government programs are always more expensive than politicians claim, and medicaid expansion is no different.
Initial Projections vs. Reality: The initial projections of costs for Medicaid expansion were significantly lower than the actual costs incurred. For instance, the Centers for Medicare & Medicaid Services (CMS) had projected that the adults newly eligible for Medicaid under the ACA would cost less to insure, on average, than other non-elderly adults already on the program. However, actual costs have exceeded these initial projections, with per enrollee spending on expansion adults being significantly higher than expected [ ([link removed] [ [link removed] ])].
Higher Per Enrollee Costs: The gap between the expected costs and actual costs has been widening over time. In 2022, the last year in the CMS projection window, expansion adults were expected to cost $4,875 per enrollee, while other non-elderly adults were expected to cost $7,195 per enrollee, nearly 50% more. This indicates a significant underestimation of the costs associated with the expansion [ ([link removed]) [ [link removed] ]].
Inaccurate Enrollment Projections: The enrollment explosion in expansion states has also contributed to the higher-than-expected costs. Estimates by various think tanks and government agencies, including the Congressional Budget Office, have consistently underestimated how many able-bodied adults would enroll if states expanded Medicaid, leading to skyrocketing costs for taxpayers [ ([link removed] [ [link removed] ])].
Unsustainable Budget Effects: The actual experience of expansion states shows that the initial per-capita cost came in much higher than expected, with new reports showing that the costs of newly eligible adults are 19% higher than non-newly eligible adults [ (www.mercatus.org [ [link removed] ])].
Misclassifications and Ineligible Enrollees: Audits in states that expanded Medicaid, such as California, New York, and Colorado, have suggested that about 10-25% of enrollees classified as newly eligible under the ACA are, in fact, either ineligible for coverage or misclassified. This artificially inflates per enrollee spending in the newly eligible group [ ([link removed]) [ [link removed] ]].
These factors combined have led to Medicaid expansion being more expensive than most people initially thought.
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