Gaines: Medicaid bloat is eating Colorado’s budget after a decade of federal expansion

By Cory Gaines | Commentary, Colorado Accountability Project

Colorado’s Medicaid bloat under Obamacare

In the first post of this series, I briefly went over Colorado’s Medicaid financing (how much and on what). If you want or need that context, it’s the first link below.

In the second part of the series, I want to talk about how Medicaid got expanded by the Feds–allowing more people to get on government-funded healthcare– and how Colorado leapt at the expansion like a shot.

There were two recent (and big) expansions of Medicaid: the first was the Affordable Care Act (Obamacare) which expanded Medicaid coverage to people (including those without any disability or children)making up to 138% of the Federal Poverty wage. Screenshot 1 is a summary of the changes, it comes from the second link below, a government site explaining coverage eligibility.

The other expansion came about in the Biden Presidency. This one came about as a result of multiple executive actions and rulemakings. Since it’s a little more complicated, I offer you two resources linked third and fourth below. One is from Paragon Health Institute, a conservative-leaning think tank which is against Medicaid expansions in general, and the other is an NPR interview with Biden’s Medicaid director. Read both, you won’t have a full understanding without having done so.

Colorado wasted absolutely no time in expanding Medicaid, they expanded it per Obamacare almost as soon as it passed. Our Medicaid program in Colorado has been expanded since 2014, I couldn’t find a reference to share, but I would bet my lunch that they also took every expansion and/or extension of benefits that Biden could dish out.

Let’s put some numbers to this, because seeing them will give you a perspective words alone cannot.

The most reliable stats I can offer come from the Federal Government’s own page on the topic. That is linked fifth below. That will take you to the MACPAC (Medicaid and CHIP Payment and Access Commission) statistics page. The current year’s stats are on that page. To see the archived data I pulled, you need to scroll down to the link labeled “MACstats Archive Page” and click there.

Note: “current” is something of a misnomer. The data lags behind the calendar date, with the most current data available (Dec 2024 is the label) actually being from 2022.

As such, when you look in links 6 – 8 below, you might see the MACstats reports being for 2024, 2022, 2020 respectively. Due to the time lag, however, the data dates from 2022, 2020, and 2018. Don’t worry if you’re confused, there will be labels in the screenshots to help you.**

The first set of data comes from the table in each report labeled “Medicaid Full-Year Equivalent Enrollment by State and Eligibility Group” and I attached them as screenshots 2a, 2b, and 2c. I cut off the table at Colorado and included the footnotes in the first screenshot so that you could see the relevant definitions of “new adult group” and “other adult”.

Roughly speaking, the Medicaid expansion, at least the relevant part for this post, falls under the heading of “new adult group” in these tables. Some summary numbers are illuminating. from 2018 to 2022, the total number of new adults on Medicaid with full benefits went from 412 to 672 (all numbers quoted here will be in thousands of individuals). This is an increase of 63%.

Over that same time period, the number of children on Medicaid in Colorado went from 435 to 517, an increase of 19%. Disabled 92 to 91, a decrease of 1%. Elderly 48 to 55, an increase of about 15%.

Let’s turn to a different set of tables now. Screenshots 3a – 3b go in the same order by date as the previous set, but this time they cover Medicaid as a share of state total (State plus Federal money) and State-only budgets. For comparison, the authors also included education up to high school and higher ed budgets for those same totals. I included the footnote in 3a so you could see the important context.

Let’s look again at summary numbers for 2018 to 2022. Medicaid as a share of total budget went from 24 to 38 percent in that time span, an increase of about 14%. Education went from about 24 and 15 for up to high school and higher ed in 2018 to 18 and 13 in that same time frame, a decrease of 6 and 2 percent respectively.

For the State-only contribution, the numbers similar. Medicaid went from 14 to 20, education up to high school 30 to 25, and higher ed 19 to 20. This is an increase of 6%, a decrease of 5%, and an increase of 1% respectively.

Before wrapping up, I want to point out that this data only covers fiscal years 2018 to 2022. As I pointed out earlier, out state expanded Medicaid in 2014 and likely took every Biden expansion and extension they could. If we had access to those numbers, my guess is that the increases you see above would only be bigger.

Let’s wrap up with some patterns.

Our state increased the number of Medicaid enrollees, people who could receive full, government-subsidized healthcare by a large amount relative to other demographic groups; while our state’s population grew, we weren’t just enrolling more traditional Medicaid patients, we were adding government dependents.

The numbers tell the story. Compare how many “new adults” joined the rolls between 2018 and 2022 and compare that increase to the number of children, elderly, traditional Medicaid patients.

While we did that, we started spending (both in terms of what we got from the Feds + the state contribution and also in terms of what we had to spend as a state) a lot more money on Medicaid. This is especially striking when you look at other, competing interests like education.

Not just that, however. We started leaning more and more on Federal dollars. Again, our state share rose slower than the state + Federal money.

Keep this in mind when you hear the rhetoric coming from those in the media and the Colorado Democrats. The numbers cannot be clearer. Healthcare is expensive and we have chosen to burden ourselves by including more people in subsidized care. We have chosen to do so by leaning more and more on Federal taxpayers. We have done so at the expense of other equally worthy groups.

While you might see lots of stories about people who would struggle without Medicaid due to Republican policy, I want you to remember that there while we had more insured Coloradans, we also have students with less money because Colorado’s Democrats chose to invest more there than in schools.

In future parts we will look at why “new adults” cost more in Medicaid and some of the ways Colorado is playing the system to get more Federal dollars.

READ THE FULL COMMENTARY AT THE COLORADO ACCOUNTABILITY PROJECT

Editor’s note: Opinions expressed in commentary pieces are those of the author and do not necessarily reflect the opinions of the management of the Rocky Mountain Voice, but even so we support the constitutional right of the author to express those opinions.