Maps: Coverage Gains and Budget Challenges and Where Obamacare would expand Medicaid most.

While the Supreme Court narrowly upheld the core of President Obama’s health care law Thursday, the justices came down hard against a provision that would have expanded Medicaid to millions more low-income Americans. As passed by Congress, the legislation expanded Medicaid to nearly everyone making up to 133 percent of the federal poverty line, which would have added an estimated 16 million people to state Medicaid rolls over the next seven years. States that refused to comply would run the risk of losing all Medicaid funding.

Seven justices ruled that the move went too far, and that the government can only withhold the funds to expand Medicaid, not existing money that helps states run their pre-expansion programs.

So will more conservative states take advantage of this new leeway and reject the expansion? That’s what Nebraska Gov. Dave Heineman, a Republican, suggested Thursday, when he said that he opposed expanding Medicaid in his state. A spokeswoman for Texas Gov. Rick Perry, who has made a show of rejecting federal funds in the past, wouldn’t say whether he would block the expansion. Medicaid is often one of the biggest lines in states’ budgets, and that share is growing as health care costs continue to rise.Source

States in Action Archive Coverage Gains and Budget Challenges  October/November 2008

The U.S. Census Bureau reported recently that both the percentage and number of people without health insurance decreased in 2007, from 47.0 million (15.8 percent) in 2006 to 45.7 million (15.3 percent) in 2007. The percentage of people covered by private health insurance actually decreased, but the drop in private coverage was more than offset by an increase in coverage through government health insurance programs.

Meanwhile, the economy took a turn for the worse, threatening to undo gains in health insurance coverage and straining state budgets. Even before the Wall Street financial crisis, the Center for Budget and Policy Priorities reported that 29 states were facing budget shortfalls in 2009, raising serious doubts about their ability to sustain gains in health coverage or consider additional reforms.

This issue of States in Action takes a close look at the Census Bureau’s health insurance coverage data, considering how coverage changed by state, and describes ways in which states are trying to stay the course to cover the uninsured in a worsening economy.

CBO:Mar 12, 2012 –

Estimates for the Insurance Coverage Provisions of the Affordable Care Act

In preparing the March 2012 baseline budget projections, the Congressional 
Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) 
have updated estimates of the budgetary effects of the health insurance coverage 
provisions of the Affordable Care Act (ACA).

1.That legislation comprises the Patient Protection and Affordable Care Act (Public Law 111-148) and the health care provisions of the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152).

The insurance coverage provisions of the ACA establish a mandate for most legal 
residents of the United States to obtain health insurance; create insurance 
“exchanges” through which certain individuals and families may receive federal 
subsidies to substantially reduce the cost of purchasing health insurance; 
significantly expand eligibility for Medicaid; impose an excise tax on certain 
health insurance plans with relatively high premiums; establish penalties on 
certain employers who do not provide minimum health benefits to their 
employees; and make other changes to prior law.

2.  CBO and JCT now estimate that the insurance coverage provisions of the ACA 
will have a net cost of just under $1.1 trillion over the 2012–2021 period—about 
$50 billion less than the agencies’ March 2011 estimate for that 10-year period 
(see Table 1, following the text).

3.The net costs reflect:
? Gross additional costs of $1.5 trillion for Medicaid, the Children’s Health Insurance Program (CHIP), tax credits and other subsidies for the purchase of health insurance through the newly established exchanges and related costs, and tax credits for small employers, 

? Offset in part by about $0.4 trillion in receipts from penalty payments, the 
new excise tax on high-premium insurance plans, and other budgetary effects 
(mostly increases in tax revenues).