HCA255 Health Care Access

Critically analyze the implications of the state’s decision to opt out of Medicaid expansion on the citizens of the state.

The beginning of the article started off very strong with the Republican views on how replacing theAffordable Care Act/ Obamacare seems to be beneficial because Americans believe that the government needs to provide healthcare for all which is “Medicare for all.” Throughout government; the left and right sides do not see eye to eye but in this discussion, they both seem to acknowledge the likelihood of this new system.

It has been one year since the implementation of the Patient Protection and Affordable Care Act, also known as Obamacare. Despite countless Republican attempts to repeal all or part of the new law, it is still with us and shows no sure signs of disintegration. The rollout of the government’s health care exchanges experienced significant growing pains right from the beginning. Time has fixed many of these technical glitches, but has done little to quell the debate over the affordability and viability of the law.

In support of Medicaid expansion in Texas, over 50 chambers of commerce across Texas have expressed strong interest in the expansion (8). Similarly, Texas Medical Association and Texas Hospital Association have also expressed their support (9). Laura Guerra-Cardus, Associate Director of the Children's Defense Fund, states "diverse groups from all across Texas support accepting federal funds to insure more Texans through Medicaid" (8). Finally, Texas Democratic officials also iterate their support by acknowledging that Texas stands alone with the highest percentage of uninsured people in the nation (10).

Ironically, Texas has the highest number of uninsured citizens in the nation, 6.2 million to be exact. The majority of these citizens are children. According to Goodwyn (2013), “by Texas refusing to participate in the Medicaid expansion, which is part of the ACA, the state will leave on the table an estimated 100 billion dollars over the next decade. It is sad to know many citizens in this state will be denied health care by those who already have the best insurance and will never have to worry about being uninsured. In addition, the Texas politicians fail to recognize the need for health care for neither its most vulnerable citizens nor the burden on the Emergency room as well as the rise in healthcare premiums for citizens who maintain health insurance. Landers (2013) reports, “whether they have a good income or a lower one, Texas lag behind much of the nation in access to and quality health care.” States who fail to expand Medicaid will see their funds distributed to states on board with expanding Medicaid.

Bill Haslam, the Tennessee state governor, announced that the state of Tennessee would accept the Medicaid expansion offer. The Medicaid expansion expands Medicaid eligibility to the region’s underserved populations living near or below the poverty line. The Medicaid expansion offer looked to be a major win for the state; however, others disagreed with this idea. Some of Tennessee’s lawmakers decided to deny the federal government’s Medicaid offer, even though many others wanted the offer to be accepted. The deal’s breakdown might be the result of “squabbling along party lines” which is a common theme at all levels of government. Although the deal was denied, it is still possible that the bill could still be passed with the help of the governor. The likelihood of Tennessee reviving its Medicaid expansion is a difficult one considering the state would have to fight. The Medicaid expansion could offer the state low-income citizens medical insurance, the state would come out of the deal with a net financial gain, and the state hospitals would come out on top.

The first reading written by Daniel Landford and Jill Quadagno show how factors such as partisans politics, policies legacy, provider groups, political values, racial groups and state fiscal capacity have cause states variation movements toward Medicaid expansion under the ACA provisions. The big question here is how? According to the authors the division between democrats and Republicans has always made republicans to be less favorable to laws introduced by democrats. Reason why we shouldn’t expect them to act differently even millions of people life is at stake. Also heath providers groups are not necessarily favorable to this law and according to the authors are the ones who can positively impact on the program. But the truth is that is that the American Medicare Association has opposed many steps that the government has made toward national health insurance. Furthermore, racial resentment has been a majors factors in shaping people thoughts about policies. States with lower racial sympathy tend to be less favorable to the program whereas the ones with higher racial sympathy are mostly favorable to the program. The last major’s point of the authors is the state financial capacity. Introducing the new law inevitably

Signed into law by President Barack Obama on March 23, 2010, the Patient Protection and Affordable Care Act (PPACA), or Affordable Care Act (ACA), ushered in a new era in the way Americans get their medical care (coverage). Guaranteeing new consumer protections and creating insurance exchanges to facilitate greater access and affordability by reducing premiums and costs for tens of millions of Americans. When passed, the ACA allowed for states to expand access to Medicaid to those previously ineligible, including some people above the Federal Poverty Level (FPL), and in its five years since passage the law has faced challenges to its component pieces, its legality, and constitutionality all together. A Supreme Court decision in 2012 ruled a key element of the ACA, the expansion of Medicaid, to be optional for the states. From that decision, 24 states and the District of Columbia have chosen the expansion option and seen success, while opposition in other states has led to efforts to block expansion, invoking a sophistic response where those living above the FPL receive federal subsidies and the most in need are left without coverage. The success of the ACA in non-expansion states – Georgia, in particular, here - depends on the state governance to make available the expansion of Medicaid for the population of their states, including opening doors for patient navigators to reach into local communities and raise awareness.

(Owcharenko 2013) Yet, that couldn’t be further from the truth. This would actually make the state spend money that they would’ve spent on something else, or wouldn’t have spent at all. (Owcharenko, 2013) Another is that they claim that rejecting expansion would mean that other states would get more, when actually that Medicaid is a calculated formula based on actual expenditures. (Owcharenko, 2013) The fewer states that expand, the less the federal government spends. (Owcharenko 2013) Deciding and fully committing to expansion can be a real predicament for the states. (Owcharenko, 2013) To regulate spending, states normally fall on usual techniques to manage cost. (Owcharenko, 2013) As Medicaid spending continues to rise, other important state priorities such as education, emergency services, transportation, and criminal justice are squeezed. (Owcharenko, 2013). If states resist balancing among spending programs, the alternative is generating more revenues with tax increases. (Foster) But higher taxes come with a steep price: They reduce economic growth, which with most states still experiencing anemic growth, tax increases on top of already higher taxes at the federal level are not an appealing option.

A number of Republican Governors, including Arizona Governor Doug Ducey, Michigan Governor Rick Snyder, Ohio Governor John Kasich and Wisconsin Governor Scott Walker, are working to finalize a repeal and replace proposal. Last week, Health System Alliance of Arizona leaders, including Frank Molinaro and I, met with Governor Ducey and his heath policy advisor and got a preview of the plan. Details include:

At present the GOP has a choice to make with regard to the fiscal abomination of Obamacare. It can either chose the path laid out for it by the Socialists on the nation’s Left and set a course towards historic oblivion. Or it can return to it’s principled roots of preserving liberty.

Due to variations in state public policy, several different independent variables will be used to examine the extent to which states have enrolled Medicaid recipients in managed care. The elderly and disabled require skilled nursing care, which has proven very expensive. Since the Boren Amendment, interpreted by the Supreme Court, refused to allow states to freeze their reimbursement rates to nursing homes and hospitals, states have seen the cost of long-term care rise rapidly. As the Baby Boom generation ages, it is expected

In the cartoon, Gov. Rick Perry insisted that the government was too intrusive in Texas with its mandate for federal funds for Medicaid expansion under the ACA (Obamacare). Yet, he not only accepted, but asked for federal help with the Bastrop Wildfires of 2011. Texas has the highest rate of uninsured people in the nation, and these less fortunate residents would greatly benefit from the Medicaid expansion at no cost to the state for at least three years. The only change of heart for the current governor may come from the possibility of a voter revolt when current funding by the federal government for the uninsured stops. If this happens, the state will face greater financial challenges in the future. However, if the state could accept federal funds for the small percentage of the population affected by the Bastrop wildfires, how could they justify not helping over 6 million Texans, a quarter of the state’s

Before the enactment of the ACA in March 2010, Arizona had already frozen the state’s version of CHIP program, KidsCare, due to budgetary concerns. Arizona was excluded from the ACA requirement of maintaining enrollment rates due to being frozen prior to the enactment of the legislation (Kaiser Family Foundation, 2011, p. 3). Statistics from the Kaiser Family Foundation (2016), shown “in 2014, approximately 176,000 children in Arizona under 18 are uninsured, the third highest rate in the country.” Currently, the Arizona KidsCare program only serves children that were on the program rolls before the freeze in January 2010. Over the last six years, many of the children have dis-enrolled due to aging out of the program, increase of family income, non-payment of premiums, and being moved into other public insurance programs such as Medicaid. Furthermore, the waiting list for the KidsCare program has increased to over 100,000 children in Arizona that are currently uninsured due to family income past the cutoff for Medicaid, but unable to afford employer-sponsored or marketplace insurance (Kaiser Family Foundation,

Governor Jan Brewer emphasized her long-lasting opposition to President Barack Obama’s signature health care law. (Duda, 2013). With Obama’s reelection and the U.S Supreme Court upholding its key provisions, the Affordable Care Act (ACA) is the law of the land (Duda, 2013). Governor Brewer has since changed her tactics. When she opened the 2013 legislative, she announced that she was seeking a full expansion of Arizona’s Medicaid program under the Affordable Care Act. Arizona then became one of the several Republican-led states that have accepted the law’s Medicaid Expansion (Scott, 2013). According to the Health and Human Services website, Arizona will see a difference with the health care law. The people of Arizona who meet the criteria for the Marketplace cover a wide range