The Expansion Of Medicaid

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

Medicaid is a social health care program that covers nearly 60 million Americans, including children, pregnant women, seniors, parents and individuals suffering with disabilities. Medicaid is the biggest source of funding for health related services and medical needs for the people with low income in the United States. This program is funded jointly by the state and federal level governments, but it is the state’s responsibility to manage this program. The Medicaid program is not a required program that states have to use, but all 50 states have implemented this program. With the introduction of the Affordable Care Act (ACA), and its passing in 2010, the ACA unveiled its plans to expand Medicaid eligibility to nearly all low-income adults as an addition to the other groups that fall into the Medicaid eligibility. The Medicaid program had “many gaps in coverage for adults” because it was only restricted to the low income individuals and other people with needs in their own specific category. In the past, the majority of the states who had adults that did not have children dependent on those parents were not eligible for Medicaid. These low income adults without dependent children would be without medical insurance assistance before the ACA was introduced. Medicaid is now available to all Americans under the age of 65 whose family income is at or below the federal poverty guideline of “133 percent or $14,484 for an individual and $29,726 for a family of four in 2011” (NSCL).

The expansion of Medicaid in the United States has often been denounced due to fear of crowd-out. Crowd-out studies have been investigated since the 1990s. Data vary from study to study with some showing no significant evidence of crowd-out to some showing up to 50% (Muhlestein, 2013). Crowd-out occurs when people choose to drop their private insurance plan in favor of enrolling in the public plan. It can also occur if public program members refuse to use private plans available or if an employer reduces coverage based on public program availability.

In every day life one must make decisions, and with decisions there comes options from which to choose from. One decision from Texas that has caused concerned has ties to one of the provisions in the Affordable Care Act. This provision wants to expand Medicaid coverage to low income Americans. However, the Supreme Court ruled a decision to make the Medicaid expansion optional for states. Therefore, Texas opted out on this idea but is still indecisive on weather or not this expansion is beneficial to the state. As we all know factors like politics enter into the mix, as does the costs of the expansion, availability, and quality of care for these new “enrollees”. The idea of medical care for all seems like a simple effective idea, but the effects overall is detrimental to Texas citizens like myself and my family, who doesn’t necessarily fit into this “mold” of the uninsured citizen the act is trying to attract. The decision Texas made to not expand, in my opinion is a reflection of all citizens who feel that they will not benefit from this implicated Medicaid program.

In 2009 there were 50.7 million people, 16.7% of the population, without health insurance. Americans all over the country are working and yet they still can’t afford to pay the high cost of health insurance for themselves and their families. Under the Affordable Care Act of 2010, which was signed by Obama on March 23, 2010, thirty two million Americans who were previously not eligible for Medicaid may now have the opportunity to be covered. If this act is passed in North Carolina then it will be expanded to cover nearly all of the 1.5 million North Carolinians who are without health insurance. If more Americans are covered under the Medicaid that they need then

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

Why is Medicaid a huge topic in Texas and how does it relate to me? This is one important question to consider. Well this paper will help shed light to the matter and illustrate the urgency for action. Just recently Texas had an option to extend Medicaid, but hastily denied. Medicaid Expansion was part of the Obama care reform in which the federal government gave the 52 states an offer to expand the current Medicaid in was that it would include the coverage of low income adults not only children. The latest on the issue is Texas had agreed on a deal but only temporarily. The agreement on the reform has given Texas some light, but not enough to reach through the other side of the tunnel. Eventually, Texas

As a health policy analyst for the state of Texas which has not elected to expand Medicaid as part of the Affordable Care Act (ACA) and now has been notified that the state leaders have taking into reconsideration their recent decision during an upcoming session in order that we begin gathering data on the benefits of adapting the Medicaid expansion. As a health policy analyst our goal is to assure data quality, interpret data, and discover new information in the data. Medicaid is a federal and state partnership with shared authority that is a health insurance program for low-income individuals, children, their parents, the people with disabilities and the elderly. Nationally Medicaid covers health care for over 72 million people. Even though participation is optional, all 50 states participate in the Medicaid program. However, Medicaid benefits eligibility varies widely among the states all states must meet federal minimum requirements, but they have options for expanding Medicaid beyond the minimum federal guideline (http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx). In this research we will identify the state of interest which is Texas, compare the state’s decision, determine the alternate approaches to expanding access and provide a recommendation on whether or not the state should opt in to the Medicaid expansion.

In a traditionalist state, such as Texas, the financial toll that Medicaid would have on its taxpayers was on the frontlines. The Texas legislature was worried about whether or not its taxpayers would face a tax increase to cover the increased cost of those covered by Medicaid. These taxpayers would inadvertently pay for the hospital bills of those who are uninsured in Texas through an average $1,800 rise in the cost of their premiums (Rapoport, 2012). In support of expanding Medicaid, Texas would receive federal funds in order to ease the cost that accompany the expansion. Since Texas decided not to expand Medicaid, Texas “would be leaving billions and billions of federal dollars on the table” according to Anne Dunkelberg (Rapoport, 2012). Not only does this monetary incentive give Texas an extra push to participate towards expanding Medicaid but it would also help the residents of the state to get insured. Texas legislators understood that this monetary incentive would not fully cover the cost of the newly enrolled Medicaid recipients. In the end, they would have to rework the annual budget and increase taxes in order to cover these extra recipients.

In the article, This Is What Happens When Your State Blocks The Medicaid Expansion Jonathan Cohn discusses the impact that the Affordable Care Act has had on the percentage of people that have health insurance in the United States. Cohn goes in depth about what the Affordable Care Act is and why it has been so beneficial to the states that have adopted it, most specifically the expansion of Medicaid. Cohn also addresses the loophole that allows states to opt out of the federal program due to a Supreme Court ruling in 2012 that allows states to block the Medicaid expansion. The new Medicaid expansion has helped lots of Americans get access to health insurance that they would not have had access to otherwise, but some states are not taking

There are some problems that must be addressed in the expansion of the Medicaid policy to include; social, economic, ethical, legal and political. First, the social impact of having health insurance removes the burden off of parents, people with chronic diseases, children and the disabled. If access to health insurance is unavailable our nation’s health care costs will continue to rise,

“15% of New Mexico’s general fund ($4.9 billion spent on Medicaid in NM) is spent on Medicaid and 61% of all federal funds received by New Mexico is for Medicaid” (KFF 2017). As reported by the KFF, adults and children make up “82% of Medicaid enrollment” while the elderly and disabled made up only “18% of enrollment.” However, there’s a disproportionate share of spending as “59% of expenditures” go towards adults and children, but “41% of expenditures” went towards elderly and the disabled Medicaid coverage. Similar examples of this inequality has led some members of congress to debate proposals to reduce federal Medicaid which would “reduce federal Medicaid spending by 41% nationally over the 2017-2026 period” (KFF 2017). This budget cut will increase the number of those uninsured, reduce healthcare access, increase the pressure on state budgets (will hurt poorer states like New Mexico the most), and can cause a decrease in economic activity at both a state and federal

There are those who believe that Medicaid should not be allowed at all, much less expanded for easier access to those who use it. Few have noted that “opponents of the ACA’s Medicaid expansion have often cried foul, claiming that it provides taxpayer-funded health coverage for able-bodied adults who choose not to work, and rely instead on the government for everything from food to shelter – and now health insurance.” (Norris L., 2016.). For some of those who are against the expansion of Medicaid, they believe that many of the Texans who are using Medicaid are able to work, and therefore can afford to provide insurance for their self. Likewise, a valid point is made when Benjamin Sommers states “there is also evidence that in 2014 some Texans who were eligible for Medicaid before the ACA, but had yet to sign up, gained coverage as a result of the “woodwork effect.” This led to a 5 percent increase in the state’s Medicaid enrollment through 2015 even without expanded eligibility.” (2016.). Arguments stating that Medicaid has already experienced an increase without expanding, due to the number of people who are gaining coverage through the Affordable Care Act would lead one to believe that expansion is no longer

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)

Other authors, however, have a different views and argued against Medicaid expansion. Baker and Hunt (2016) have argued that the expansion policies are rooted in ideology that favors personal responsibility over society’s responsibility in caring for the public’s health. They are more political than logical. Conover, Christopher J. (2017) argues that in the long run Medicaid Expansion is unaffordable and financing it encourages fiscal irresponsibility. Wright et al. (2016) analyze the Iowa