Sen. Graham Complains That 3 Blue States Get a Third of ACA Funding

Sen. Lindsey Graham has by no means been a fan of the Reasonably priced Care Act — though it’s helped dramatically decrease the variety of uninsured individuals in his residence state of South Carolina.

The Republican, who heads the Senate Judiciary Committee, attacked the legislation on the affirmation hearings for Supreme Court docket nominee Amy Coney Barrett. Democrats have made the nomination a referendum on the well being legislation, which would be the topic of a Supreme Court docket listening to on Nov. 10. They concern the courtroom might overturn the whole legislation, which has led to very large expansions in protection and blocked insurers from discriminating in opposition to individuals with preexisting situations, amongst different client protections.

Graham advised that South Carolina was getting the quick finish of funding as a result of the well being legislation is sending a disproportionate quantity of its cash to states represented by Democrats in Congress.

“Beneath the Reasonably priced Care Act, three states get 35% of the cash, of us. Are you able to title them? I’ll assist you: California, New York and Massachusetts. They’re 22% of the inhabitants. Sen. [Dianne] Feinstein’s from California, [House Speaker] Nancy Pelosi’s from California, Chuck Schumer, the chief of the Democratic Senate, is from New York, and Massachusetts is [Sen.] Elizabeth Warren. Now, why do they get 35% of the cash once they’re solely 22% of the inhabitants? That’s the way in which they designed the legislation: The extra you spend, the extra you get.”

His assertion obtained us questioning if these numbers are true.

Sophisticated Math

We requested Graham’s workplace for proof to assist his assertion. His spokesperson responded with information he stated was from the Facilities for Medicare & Medicaid Providers in addition to the Medicaid and CHIP Fee and Entry Fee, a congressional advisory board.

To have a look at whole spending beneath the ACA, Graham’s workplace analyzed federal cash that went to pay for the Medicaid growth, tax credit given to customers to subsidize premiums of insurance policy on {the marketplace}, price sharing discount subsidies (which got to insurers to defray a few of the prices they have been required by the ACA to select up for market prospects with very low incomes) and the Primary Well being Program, which is an possibility within the ACA that lets states provide low-income residents totally different protection than plans supplied on the marketplaces.

Graham’s workplace didn’t share the precise studies used for the evaluation, however staffers stated they used 2016 information, though newer information was accessible. The numbers have been primarily based on calculations made in 2017 when Republican lawmakers sought to repeal and change the ACA. Their evaluation confirmed $118 billion in whole 2016 federal spending on the ACA, with California, New York and Massachusetts receiving about $43 billion, or about 37% (barely increased than what Graham cited on the listening to).

Almost two-thirds of the funding was attributed to the growth of Medicaid to all adults beneath the federal poverty degree. The Supreme Court docket dominated that pursuing the growth was an possibility left to states’ discretion — South Carolina opted in opposition to it. The federal authorities paid all these Medicaid prices from 2014 by 2016 for brand spanking new enrollees after which steadily diminished its share to 90% at the moment.

We determined to independently take a look at the spending utilizing the most recent accessible numbers. We reviewed federal information compiled by KFF in addition to information offered instantly from the U.S. Facilities for Medicare & Medicaid Providers and the states, when needed. (KHN is an editorially unbiased program of KFF.)

You will need to word that the Trump administration ended the associated fee sharing discount funds in October 2017. So, KHN’s evaluation didn’t embrace spending for that program.

We analyzed the most recent Medicaid growth funding from 2018 and the most recent Obamacare tax credit score spending and likewise Primary Well being Program spending from 2019. Solely two states take part in that program, New York and Minnesota.

Including up the most recent information and the federal share of funding got here to almost $140 billion. Of that quantity, New York, California and Massachusetts — which signify about 20% of the nation’s inhabitants — obtained a mixed $40 billion, or about 29%.

The most important class of federal funding by far was the almost $27.5 billion the three states collectively obtained from Medicaid growth.

New York obtained about $5 billion in fiscal 2019 for the Primary Well being Program.

Sifting by older datasets, one key discrepancy stands out within the figures utilized by Graham. He lists Massachusetts as receiving $6.1 billion in federal alternate subsidies — nearly 20% of the nationwide whole — whereas federal information utilized by KFF in 2016 cites $360 million.

Graham insinuated that South Carolina wasn’t getting its justifiable share of cash, calling the legislation “a catastrophe for the state.”

However the refusal by the state’s Republican leaders for the previous seven years to develop Medicaid — which might have introduced in billions of federal {dollars} — is the primary cause for the funding disparity. South Carolina is one among 12 states that haven’t adopted Medicaid growth.

That call has left a whole lot of hundreds of the state’s residents uninsured as a result of they’ve incomes too excessive for Medicaid however too low to qualify for federal subsidies to assist them purchase insurance policy offered on the ACA marketplaces. To qualify for a subsidy, customers’ revenue have to be not less than on the federal poverty degree, or $12,760 in 2020.

“An enormous driver of the move of federal funds is said to that call about whether or not to develop,” stated Larry Levitt, KFF’s govt vp for well being coverage. “It’s not inherently within the design of the legislation.”

If South Carolina expanded Medicaid, about 330,000 extra residents could be lined and the federal authorities would give an extra $1.6 billion in annual Medicaid funding to the state, in accordance with an evaluation by the City Institute. State Medicaid spending would rise by $250 million.

Even with out increasing Medicaid, the uninsured price in South Carolina has dropped from 20% in 2008 to about 13% in 2019, in accordance with Census information.

Greater than 9 in 10 individuals within the state who get protection by the ACA market get tax credit to assist them pay their month-to-month premiums.

The truth is, South Carolina will get a bigger share of these premium tax credit than most states. South Carolina, the nation’s Twenty third-largest state by inhabitants measurement, ranks eleventh within the variety of residents getting these subsidies and ninth in receipt of the federal ACA premium subsidies, in accordance with the federal information.

Drawback for ‘Fiscally Accountable States’

Kevin Bishop, a spokesperson for Graham, stated the purpose of the senator’s remarks is that the ACA “is structured in order that states that both expanded [Medicaid] or have favorable state eligibility may have a disproportionate share of funds. This provides a bonus to high-spending states.” States which are extra “fiscally accountable” are at a drawback, he stated.

Bishop acknowledged that ACA spending does change every year.

Levitt famous that Graham’s critique omitted an vital perspective about different states. The senator didn’t point out that enrollees in two Republican-controlled states with massive populations, Florida and Texas, obtain extra in ACA premium subsidies than individuals in New York or Massachusetts. Nevertheless, neither of these Southern states has expanded its Medicaid program.

Nonetheless, specialists famous that Graham’s remark that the extra states spend the extra they get from the ACA is partly true.

It precisely displays the ACA’s Medicaid components. As states develop Medicaid eligibility, they decide up extra bills and likewise obtain more cash in a federal match.

Joe Antos, a well being economist with the conservative American Enterprise Institute, stated Graham is right that the Medicaid growth was designed to assist direct extra funding to wealthier states equivalent to New York, California and Massachusetts. These states, in addition to some others, had broader Medicaid eligibility guidelines than poorer states earlier than the legislation was enacted, so their Medicaid rolls have been comparatively bigger already.

That’s why the Medicaid growth was set at 138% of the federal poverty degree, reasonably than 100%, he stated. The upper quantity meant these states might get a bigger reimbursement for individuals already of their program.

However he stated states that selected to not develop Medicaid beneath the legislation can’t blame the legislation for getting fewer federal {dollars}.

“If a state didn’t develop, it’s on them for having much less federal funding,” Antos stated.

Ed Haislmaier, a senior analysis fellow on the conservative Heritage Basis, stated the growth of Medicaid for these extra progressive states considerably elevated their funding. “New York made out like a bandit,” he stated, noting the state had one of many nation’s largest Medicaid populations earlier than 2010.

Our Ruling

Graham factors to increased federal spending on ACA packages in three states which are represented by high congressional Democrats and complains that South Carolina will not be faring as nicely. Whereas his numbers are 4 years previous, the most recent numbers are only a few proportion factors decrease than what he cited — 29% in contrast with 35%.

He additionally overlooked some crucial data — most vital, that South Carolina didn’t pursue federal funding by Medicaid growth.

His argument that the legislation was designed to assist some states largely managed by Democrats fails to notice that many Republican-controlled states have obtained heavy federal funding, too, both due to ACA tax subsidies or Medicaid growth, or each.

He additionally didn’t acknowledge that South Carolina does have a robust file of receiving federal subsidies for customers shopping for insurance coverage on the ACA market.

We price Graham’s assertion as Half True.