WHY NOT EXPAND?Medicaid expansion (and Obamacare) is instrumental in the well-being of American citizens,

and states’ decision not to expand prove detrimental to millions of Americans

MEDICAID ELIGIBILITY AND EXPANSION

Medicaid eligibility has expanded largely since April 1st of this year. Financial eligibility has expanded to anyone who makes 138% FPL (Federal poverty line), equating to $16,104 for an individual and $27,310 for a family of three. Because of this, parents’ eligibility has risen in 16 states, from 106% FPL in January 2013 to 138% in April 2014. In addition, coverage is available to more groups that were previously ineligible, including childless adults. Previously, Medicaid was predominantly aimed toward the disabled and elderly, whose coverage continues to expand. Now, pregnant women and poor children have many more coverage options as well. The care provided by Medicaid insurers is generally as adequate as that provided by private insurers. Yet the expansion has created new challenges with a large demand for family and general practitioners. !The Medicaid expansion has also significantly improved state economies. States don’t spend nearly as much money on Medicaid as the federal government does; only about 16% of costs are paid by states, and the federal government pays for the remaining 84%. The Medicaid expansion relies heavily on federal government’s economic support, covering 100% of expansion costs in the first 3 years, and 90% there forward. In terms of politics, Democrats predominantly support Medicaid expansion, and a survey taken by the Commonwealth Fund found that 74% of newly insured Republicans are happy with their new care. Also, 87% of people said they were somewhat or very satisfied with their care post-expansion. !!!

Tables A and B compare the characteristics of newly eligible and currently eligible uninsured adults for Medicaid and their incomes. !

Figure 3 shows eligibility for currently uninsured adults compared to if all states expanded Medicaid.

(Charts taken from pdf from the Urban Institute: Research of Record’s website)

(Image taken from the Henry J. Kaiser Family Foundation website)

NON-EXPANDING STATES AND THE COVERAGE GAP

For states choosing not to expand, there are many detrimental effects for American citizens. First and foremost, 4.1 million poor Americans are falling into a coverage gap in which they make more money than Medicaid covers (<100% FPL), but not enough to qualify for premium tax credits to help them pay for Marketplace coverage. Also, the median eligibility for parents in the 24 states choosing to not expand is only 49% FPL, which connotes an extremely low income, close to impossible to earn in a whole year’s time. People that fall into the coverage gap have no affordable options for insurance, leaving millions not covered. Arguments against expansion include not having faith in the federal government to provide their share of costs, lack of economic gain, lack of effect on stress from new funding, and the possibility of the expansion harming Republican government officials. !!Figure 2 shows current eligibility of uninsured adults in non-Medicaid expanding states if their states were to

expand. !

Figure 4 shows the non-Medicaid expanding states in which 4.8 million non-elderly uninsured people live.

(Images taken from the Henry J. Kaiser Family Foundation website)

THE HOUSE’S BUDGET PLAN AND CURRENT ACA NEWS

!To refute the Medicaid expansion, some states are attempting to work with the Obama administration to negotiate waivers that give them more healthcare options, but in no way condoning or agreeing with Obamacare. Also, The House’s budget plan proposes that Medicaid should be converted into a block grant, capping federal Medicaid payments to each state at a specified dollar amount. This would limit program growth below expected values based on enrollment and healthcare inflation to save money. The plan is said to lower Medicaid costs by 38% by 2022. According to a recent study done by the Huffington Post, charity costs in hospitals in expanding states have decreased from $2.8 million to $1.9 million since the expansion. In states that decided to not expand, costs have risen from $3.8 million to $4.2 million. !In current ACA news, unnecessary and foolish drama is going on regarding tax subsidies for state exchanges. About two years ago, The Supreme Court decided it was a state’s choice to accept or reject establishing their own exchanges, and 36 states, including DC, decided to reject setting up state exchanges. Because of this, 5 million Americans in these states have been receiving subsidies from the federal government. Now, drama is brewing over a specific line in the Obamacare plan regarding state exchanges. The wording in the law, “state exchanges”, assumed that every state would establish their own exchange, considering that the Supreme Court hadn’t made the decision that it was a state’s choice yet. Republicans have always wanted to defeat this law, as at the core they believe that it is unconstitutional for people to be required to have insurance. The Obamacare plan fundamentally refutes this thought, as they want to expand coverage to everyone. Rather than addressing their decision to not establish state exchanges, many Republican run states are challenging the Administration over the exact wording of the law, saying that funding can only come from state exchanges and it was a mistype on the Administration’s part.

!The map shows states’ exchange decisions.

(Image taken from the Washington Post’s website)

MY ISSUE: POLITICS AND HEALTHCARE

Essentially, the heart of the issue I have with the current arguments about healthcare is how everything is so involved in politics. What really needs to be addressed is the issue at hand, millions of people are uninsured and what Obamacare aims to do is expand coverage for all. Currently, we see that so many Americans are being kept from getting coverage because of the state they live in, often paralleling with the political affiliation of their governor. (Bar graph below) Medicaid expansion and the Affordable Care Act provide so many more options in terms of care to citizens, for example, now people can go see the dentist or get a check up if they need to. Obamacare is a bipartisan plan whose main focus is that no one should be turned down for coverage for any reason. This bipartisan idea has become a political issue, when it never had anything to do with politics. In the end, the Affordable Care Act provides health services for millions of Americans and save states millions of dollars.

(Image taken from the Washington Post’s website)

WHY COVERED CALIFORNIA IS DOING IT RIGHT

The epitome of the way Obamacare is and was intended to function can be credited to Covered California. Paul Krugman, blogger of the New York Times, discusses why Covered California shows the possibilities that Obamacare has to offer. He makes three main points as to why Covered California is so effective; “the website worked pretty well from the beginning, Medicaid expansion was implemented, and the state worked hard on outreach”. California has shown through its staggering numbers, that Obamacare really works. So I think every state should follow in California’s footsteps and make more of an effort to get America covered. !!

The image below depicts the sources of coverage of California’s previously uninsured.

(Image taken from the Henry J. Kaiser Family Foundation website)

Presentation by: Sarah Boehm

THANK YOU !

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