> I'm arguing it may still make sense to move, pay out of pocket for the 366 days, and gain residency for some folks. It's trivial to construct a threshold and

> I'm arguing it may still make sense to move, pay out of pocket for the 366 days, and gain residency for some folks. It's trivial to construct a threshold and out of state pay structure which cancels this case out. What number of days and out of state pay structure do you feel would cover these cases? How many of these cases do you suspect will occur annually and what is the projected cost? It's a relatively easy problem to solve once we get down to the specifics. > "you can't be a resident, ever, if you've got expensive healthcare costs" Great! I'm not arguing for "ever". I think we're in the clear here. Edit: Let's estimate the volume of this effect using migration after Medicad expansion as a proxy. Over 10 years (2009 to 2019) we find 56,659 interstate moves after Medicaid enrollment growth[1]. In other words, 0.23 percentage points greater annual population growth in the target population. Another study found an in-migration rate(to CA) of 1.4% for medicaid recipients. Being generous and taking the higher of the two, and multiplying it by California's net immigration of 500,000–600,000 annually, gives us an estimated 7000-8400 medicaid migrants a year a fraction of which are migrating primarily for medical purposes. What would you estimate the annual medical expenditures for this group would be and if an "new arrivals" insurance pool was formed, what would the marginal monthly premium cost be to its members? I estimate that a CA new arrivals insurance pool would have $4B in annual disbursements, and $4-20M in annual residency fraud. Using averages, we can estimate a monthly premium for this group would be about $667/month. This is roughly on par with unsubsidized ACA premiums for adults in many states. For comparison, ACA benchmark premiums for a 40-year-old in California in 2024 are about $450–$600/month. 1. https://pubmed.ncbi.nlm.nih.gov/39893838/ https://pubmed.ncbi.nlm.nih.gov/39893838/ 2. https://pmc.ncbi.nlm.nih.gov/articles/PMC4011649/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4011649/?