Medicaid Expansion In Missouri

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

The concept of providing basic healthcare services to individuals in need has undergone an agonizing transition, from a luxury once only afforded by the affluent to a basic human right granted to citizens of every economic station, and the recently enacted Affordable Care Act (ACA) was designed to finalize this ethical evolution. Reflecting perhaps the bitter political enmity currently consuming the nation's once cherished democratic process, Republican legislatures in states throughout the union have bristled at the ACA's primary provisions, threatening all manner of procedural protestation as they attempt to delay and derail the bill's eventual implementation. One of the most intriguing aspects of the sprawling, thousand page law, however, has been the stipulation that individual states will be given a choice to either accept federal funding to expand their statewide Medicaid roster, or to forfeit all federal funding for that program in perpetuity. The role of government in monitoring and regulating the healthcare industry has been long debated, and the bitterly contested passage of President Obama's ACA, a law aimed at revising the country's health insurance system through the creating of a federal health insurance exchange to facilitate increased competition among insurers, has rekindled the debate over who holds the ultimate responsibility for regulating the care provided by hospitals, community clinics, and private practices.

In a survey conducted in 2003, it highlighted that the recurrent problem is the reimbursement rate from Medicaid to the physician (O’Shea, 2007). The Center for Studying Health System Change (HSC) show that 21% of physicians that state they accept Medicaid have reported they will not accept a new Medicaid patient in 2004-2005(O’Shea, 2007). This number would only logically be assumed to have risen in 2013 A survey conducted by the U.S. National Health reported that researchers have found two standout trends among Medicaid beneficiaries: they have more difficulty getting primary care and specialty care and they visit hospital emergency departments more often than those with private insurance (Seaberg, 2012). The lack of primary and specialty care access is mostly contributed to the following barriers; unable to reach the MD by phone, not having a timely appointment with the MD and lastly unable to find a specialty MD that will accept Medicaid. In a recent report released by the Partnership to Fight Chronic Disease, it stated that about 30% of Medicaid patients experience “extreme uncoordinated care”, there is a strong correlation between this situation and higher Medicaid spending and less quality of care given (Bush, 2012). After January 1st 2013, healthcare providers have experienced a 2% reduction in payments for Medicaid beneficiary, this will only create more of a problem for these patients to seek the

Texas, which currently has a large uninsured population and limited Medicaid eligibility, forfeits billions of dollars from the federal government every year by not expanding its Medicaid program as implemented in the Affordable Care Act. In contrast, Medicaid expansion could benefit the state exponentially and give its citizens the fullest potential of what this country offers. A substantial amount of federal funding that could increase uninsured coverage, improve healthcare costs, and provide economic stimulus is left on the table. Additionally, the nation benefits when each state participates, contributing to the success of the healthcare reform.

The potential opportunity for the state to opt into the Medicaid expansion is the fact that low-income citizens will be insured. The decision of the state to opt into the Medicaid expansion will also impact the state’s budget, and this is the main challenge (Frakt, 2013). The government will cover majority of all the cost even as Medicaid expansion provides coverage for the low-income uninsured citizens. Expansion of the Medicaid is also a broken system that has poor outcomes, not severe federal strings, high inflation and no incentive for the personal responsibility of the citizens who

Some may argue that the expansion of Medicaid is a bad idea because of the potential shortage of healthcare professionals. A new study has predicted that the expansion of Medicaid could lead to a shortage of 52,000 primary care physicians by 2025, it also states that visits to the doctors will increase from 462 million a year to 565 million a year, which will strain the system. Its also

Medicaid has help many qualified Americans who were historically unable to access health care. At the same time, it has raised questions and controversies as how efficient is the plan overall. Various research studies were conducted and contradicting results were presented. According to Paradise and Garfield (2013), some said that having no coverage at all is better that having a Medicaid coverage. On the other hand, some expressed that Medicaid paved a way to improved health due to increased access to services that provides prevention of diseases, health maintenance, and effective treatment (Paradise & Garfield, 2013). As for me I am in favor of the later, health care access for all. It comes down to equitable distribution of resources

In March 2010, one of the most controversial bills in modern history was signed into law by President Barack Obama. The Patient Protection and Affordable Care Act expanded the 1965 bill passed under President Johnson that created Medicare and Medicaid (“LBJ Presidential Library,” 2015). While the Affordable Care Act, or “Obamacare” as it has been dubbed by the media, has many components, the focus here is the expansion of Medicaid. Obamacare sought to expand Medicaid to cover those who earn too much to qualify for traditional Medicaid, but not enough to afford employer-provided health care. These people are said to be in the “coverage gap” (“Obamacare Medicaid expansion,” 2015). While only 32 states have adopted Obamacare, we should advance a policy encouraging the remaining states to expand existing coverage by extending the period of federal government cost-sharing an additional five years. Doing so would give states previously refusing the cost sharing a second chance to opt-in. This expansion would save money for the states from some of the rising cost of healthcare, and fulfill our moral duty to care for uninsured Americans.

Texas has the largest uninsured population with an estimated 6.2 million uninsured citizens within its stateliness, approximately a quarter of the statewide population (Rapoport, 2012). In 2012, then governor, Rick Perry decided that Texas would not expand Medicaid under the Affordable Care Act (ACA). This decision led to much debate over whether or not Perry made the right decision to leave upwards of a million Texans, who did not receive insurance subsidies and did not qualify for Medicaid, uninsured. These Texans fell under what many politicians refer to as the “coverage gap.” Texas decided not to expand Medicaid under the Affordable Care Act because of the effects it would have on hospitals, financial reasons, and increased number of

Since the implementation of the Affordable Care Act (ACA) in 2010, there has been a continuous debate about the effects it will have on the United States economy. Many people argue that expanding insurance coverage for all people will create crippling cost burdens for the economy and taxpayers. While others believe that the ACA will in fact give the economy a much-needed boost. In 2006 as a measure to improve overall healthcare, the state of Massachusetts implemented the Health Care Insurance Reform Act. This paper looks at the positive and negative effects of the Massachusetts Health Care Insurance Reform Act (MHRA). Using a literature review of public health studies ranging from 2009-2012, I argue that there are both positive and negative effects of the Massachusetts Health Care Insurance Reform. While the Massachusetts Reform increased health insurance coverage for all citizens and decreased the number of uninsured citizens accessing emergency rooms, it also did very little to decrease already existing racial, ethnic, and socioeconomic disparities among minorities and whites in the state of Massachusetts. Understanding the Massachusetts Health Care Insurance Reform Act may help in the goal of trying to achieve near-universal healthcare. This paper provides an understanding of the missing pieces in the Massachusetts Health Care Insurance Reform Act and constitutes a starting place from which to understand the Affordable Care Act.

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.

By expanding Medicaid what will be the effect on the people is the question? For instance, where you live will affect the cost someone could pay for care, and affect how much someone might pay for their Medicaid benefits ("How Much Does Obama Care (Affordable Care Act or ACA) Cost in Texas?"). Under the Affordable Care Act on one can be turned down for coverage because of a pre-existing conditions or age and various other things. ("How Much Does Obama Care (Affordable Care Act or ACA) Cost in Texas?"). Having the insurance is good and well but if the patient care is below the standard of care these the insurance is no good to the people, but the state of Texas they have made legislation for that reason. For example, the Texas Medical Board and the Medical Practice Act. Texas Medical Board will “investigates complaints against physicians, physician assistants, acupuncturists, surgical assistants, respiratory care practitioners, medical radiologic technologists, medical physicists, and perfusionists.” ("Texas Medical

Also by rejecting the Medicaid expansion community-based providers, including hospitals are casualties. Hospitals will continue to provide care to the uninsured without sufficient compensation, increasing shift costs to the privately insured. This also has a chilling effect on enrollment in private insurance plans through the new federally facilitated marketplace. Opposing the Medicaid expansion also ignores the real needs of the uninsured and the massive financial burden shouldered not only by the hospitals but taxpayers and businesses. (Stultz, 27)

     Most of the people who are uninsured are the working poor, which the overall costs of medical care can hurt them. By the means of doing their best, these people just can’t afford the insurance. Health care has become increasingly unaffordable for businesses and individuals. (Reese) Premiums grow several

In Massachutettes, health plans wanted to eliminate “continuous open enrollment, assess the full annual penalty for any significant period of continuous un-insurance, impose waiting periods for certain services and bar consumers from buying in the merged market if they had access to employer sponsored coverage” (case study). Doing these things, the insurance companies hoped to lower premiums. Bill 2585 did pass but the law did not go as far as the insurance companies had hoped. It only “limited open enrollment in the merged market to twice a year in 2011 and once a year after that” (case study), which didn’t really help much. Due to loss in the small market group in 2009, health plans “planned double digit premium increases in 2010” (case study), but the government stepped in and put a stop to it. Even though the big name hospitals were driving up cost, the insurance companies were seen as the bad guys. This caused local plans to “record sizable operating losses for the first quarter of 2010 and had to draw on reserves to cover expected losses resulting from the rate rollbacks” (case study). The insurance companies, especially the smaller ones, suffered financially.