Medicaid by State and Age Group in FY 2019: Curiouser and Curiouser

The Centers for Medicare and Medicaid no longer provides state-level data on Medicaid expenditures and beneficiaries by age group, but it does provide state-level data on enrollment, expenditures, and expenditure per enrollee by “basis of eligibility.”  Spending per enrollee isn’t as good as spending per beneficiary in analyzing how much is being charged by the health care industry, because expenditure per enrollee is affected by the number of people enrolled who do not currently require expensive care.  And basis of eligibility is not as good as more detailed age groups, but it at least does provide separate data for children (under 18), non-disabled adults (18 to 64), seniors (65 and over), and disabled adults and children.  

When I looked at the per enrollee New York State data for FY 2019, however, I found it was reported to be far below the level of 2018, and even below the U.S. average for children and non-disabled adults.

Why?

Health Care and Aid to the Needy: Census Bureau State and Local Government Finance Data for FY 2004 and FY 2014

New York City was long known as America’s welfare capital, with a large dependent poor population and extensive services for them. But one doesn’t hear much about that anymore. New York State has also had the highest Medicaid spending in the United States, but one doesn’t hear much about that anymore either. The data shows New York still spends more on aid to the needy than most other states, as a share of its residents’ personal income, but the gap between New York and the rest of the country closed between FY 2004 and FY 2014. As the gap closed, aid from the federal government to New York shifted to other places. Today, moreover, most of this “social” spending is on health care, and thus on older people, not on those with lower incomes.   A discussion of these trends, with tables and charts, follows.

Federal Expenditures: A Government Transformed

Just based on the news, it would be easy to believe that not much had changed for the federal government during the Obama Administration, other than Obamacare. After that program passed, barely, the Republicans took Congress, and there has been a stalemate – with shutdowns, possible defaults, and a sequester that was meant to force compromise by taking both sides hostage, but turned out to be the actual public policy.

Now that I’m looking at the data, however, I see things completely differently. Obamacare is nothing but a blip in the relentless increase of health care as a percent of the federal budget, mirroring its ongoing increase in the economy as a percent of GDP. The sequester actually did shrink federal spending in the limited areas to which it applied, something people don’t realize because the limited federal government operations people actually see have continued to stagger on the for the moment. Meanwhile, demographic and economic changes have completely re-shaped federal expenditures based on programs that were enacted before Obama and the Tea Party were even elected. Notably the increase in the share of the population that is age 65 or over, and the share of the workforce that is working poor rather than lower middle or middle class. The result is a government completely transformed in a way that is in once sense alarming, but in another sense hopeful.