The Kaiser Family Foundation released “The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis” in November. (Dick mentioned it in a post earlier this week.) Thanks to the June Supreme Court decision on the Affordable Care Act, states may choose not to implement the law’s Medicaid expansion. (There had been some question about whether states could choose to only partially implement the expansion, but the Department of Health and Human Services said this week that the federal government will only fund full implementation.)

The Kaiser study finds that even if states don’t implement the expansion, Medicaid enrollment will still increase, due to increased participation by current eligibles.

For Washington, the study estimates, implementing the expansion would increase state spending by $1.4 billion and total spending by $11.6 billion over the 2013-2022 period. Washington’s baseline Medicaid spending (without the ACA) over that time ranks 12th highest in the nation; under the ACA, it would remain 12th highest with or without the expansion.

Washington ranks 14th highest in Medicaid enrollment in the baseline (no ACA), with 1.08 million enrollees in 2022. That number would increase by 90,000 under the ACA but without implementing the expansion, and by 227,000 with implementation. If all states implement the expansion, Washington would drop to 17th highest enrollment in 2022. The total uninsured under the no ACA baseline is 840,000 in Washington (18th highest) in 2022; it would be reduced by 223,000 with expansion. If all states expand, Washington would rank 13th highest in uninsured.

Washington’s state Medicaid expenditures would be $60.1 billion under the ACA with no expansion. With expansion, that number increases by $121 million. But, according to the study, savings in uncompensated care would reduce that spending by $119 million.

Using data from the National Association of State Budget Officers, the study estimates that Washington state general fund expenditures will total $202.6 billion over 2013-2022. With the expansion, Medicaid would represent 29.7 percent of Washington’s general fund spending.

The study assumes that costs per Medicaid enrollee will rise from $5,440 in 2016 to $7,399 in 2022. According to Stateline today, “for states, Medicaid is still the biggest budget worry for the coming year.”