Health Management Associates (HMA) has modeled what could happen with health insurance coverage in the states during this downturn. They consider low, medium, and high unemployment scenarios and find that, nationally, “All three scenarios result in a significant shift from the number of Americans covered by employer provided insurance to some form of Medicaid or a Marketplace plan.”

The Health Benefit Exchange’s May 2019 enrollment report (the most recent one available) shows that Medicaid clients in Washington totaled 1,466,858 and enrollees in qualified (private) health plans through the Exchange totaled 196,327.

The table shows HMA’s estimates for Washington. Medicaid enrollment could increase by 256,000 (17.5 percent) in the low unemployment scenario to 546,000 (37.2 percent) in the high unemployment scenario. Exchange enrollees could increase by 18,000 (9.2 percent) to 82,000 (41.8 percent).

The Exchange opened a special enrollment period on March 10 and has extended it through May 8. The Medicaid and CHIP Payment and Access Commission reports that in FY 2018, Washington’s Medicaid program cost $12.827 billion. The state paid for $4.868 billion of that and the federal government covered the rest.

It’s hard to say how much it would cost the state if 256,000 or more people qualified for Medicaid. Not all populations within Medicaid are subject to the same federal matching rates. For example, for the group that is eligible due to the Affordable Care Act’s expansion of the program, the federal government pays 90 percent. In general, the federal government pays 50 percent, but Congress increased that match by 6.2 percentage points as part of the second coronavirus aid bill.

Still, it is certain that these possible changes to how Washington residents are insured (especially the increases in Medicaid clients) would have a big impact on the state budget.