The Issue: Which taxpayers get best ROI on healthcare tax dollar?

By NICOLE DEBEVEC, United Press International  |  Jan. 5, 2014 at 5:01 AM
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Taxpaying residents in states expanding Medicaid coverage to accommodate the sweeping 2010 healthcare reform law could see a return on their investments of as much as $5.11 for every additional dollar in income taxes they'll pay to fund the Affordable Care Act, a report found.

Conversely, taxpayers in states that chose not to expand Medicaid coverage could leave on the table as much as $8.03 in free federal funding for every dollar they're set to pay to fund healthcare improvements.

"Taxpayers across the country are on the hook for Medicaid expansion costs no matter what, as federal income taxes are used to fund the program," WalletHub CEO Odysseas Papadimitriou said last week in a release. "The only question is whether or not they get anything in return."

"As things currently stand, the expected benefits vary significantly based on geography," Papadimitriou said, "and depending on one's current healthcare coverage, this could even be a reason to move."

President Obama signed the Affordable Care Act, aka Obamacare, into law March 23, 2010, and his signature legislation has since been at the fore of public consciousness and divisiveness, including the subject of dozens of votes in the Republican-controlled House meant to derail or defund it, the subject of a Supreme Court case, and the victim of technical difficulties when online health insurance marketplaces were launched.

The law has also morphed significantly since its passage. While ruling that the Affordable Care Act was, indeed, constitutional, Supreme Court altered the scope of the law's prescribed Medicaid expansion by ruling states had the right to decide and lessening the penalties for opting-out. The White House, too, messed with the bill -- deciding to delay for a year the law's mandate that employers with more than 50 employees provide health insurance.

Because so many provisions of the Affordable Care Act have been tweaked and so many deadlines have been delayed, confusion surrounds what actually took effect Wednesday, Day 1 of 2014. Among the provisions that went into effect were the expansion of the small business tax credit and implementation of the health insurance tax insurance carriers

The report's assessment looked at how the Affordable Care Act would affect each state strictly based on economics, taking in both state government and individual perspectives. Specifically the report analyzed public data using 11 metrics designed to gauge the impact of key provisions of the law on major consumer segments as well as each state's budget to determine the overall rankings for the states that would benefit most and least.

Vermont tops the list of ROI winners, followed by West Virginia, New York, Kentucky and Oregon. Leaving the most money on the table was Mississippi, followed by South Carolina, Alabama North Carolina and Montana.

Other conclusions?

States such as Vermont, Massachusetts, New York, Delaware and Maryland save money on Medicaid expansion, meaning the additional federal dollars they will get exceed the added cost of expanding Medicaid coverage per ACA. But even the lowest ranking states will pay only pennies -- as much as 27 cents -- for each federal dollar they get.

Changes in health insurance premiums vary widely from state to state. said its study found the average health insurance premiums were expected to stay the same or drop in nine states because of the Affordable Care Act, with New York, Colorado, Ohio, Massachusetts and New Jersey forecast to see reductions as high as 40 percent. However, premiums are expected to rise as much as 180 percent in states such as Vermont, North Carolina, Arkansas, New Mexico and Nevada.

Consumers across the country will be able to save thousands of dollars on out-of-pocket expenses because of Obamacare. The savings will be highest in Alaska, where consumers who spent above the Affordable Health Act-mandated caps in 2012 will save more than $2,000 annually on average. Average yearly savings are expected to top $1,000 in even the lowest-ranking states such as Hawaii and Arizona.

While consumers save on out-of-pocket expenses, states are expected to save as much as $235 per capita on uncompensated care, said. The healthcare law is expected to ease the uncompensated-care burden on state hospital systems by lowering the number of low-income uninsured individuals who must be treated for developing health issues but can't pay. The range of savings was the highest -- from $185 to $235 -- in Kentucky, Delaware, West Virginia, Arkansas and Nevada. Washington, Arizona, the District of Columbia, Hawaii and Massachusetts would save the least, ranging from $22 to $70.

Populations expected to benefit most from the prohibition of coverage denial because of a pre-existing condition mainly are West Virginia, Kentucky, Mississippi, Ohio and Alabama, reported.

Finally, said, a state's access-to-care ranking reflects healthcare access and affordability, as well as the number of licensed physicians per capita. Based on this data, the District of Columbia, Hawaii, Massachusetts, Vermont and Delaware are best positioned to handle the influx of newly insured residents while Idaho, Georgia, Mississippi, Nevada and Texas may encounter the most difficulty in this regard.

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