US Healthcare Reform Landscape - Addendum to June 2018 Presentation to the Ch...
MedicaidObamacare Presentation Final 2
1. 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
2. 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.
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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.
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Tables A and B compare the characteristics of newly eligible and currently eligible uninsured adults for Medicaid and their incomes.
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Figure 3 shows eligibility for currently uninsured adults compared to if all states expanded Medicaid.
3.
4. (Charts taken from pdf from the Urban Institute: Research of Record’s website)
6. 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.
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Figure 2 shows current eligibility of uninsured adults in non-Medicaid expanding states if their states were to
expand.
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Figure 4 shows the non-Medicaid expanding states in which 4.8 million non-elderly uninsured people live.
9. THE HOUSE’S BUDGET PLAN
AND CURRENT ACA NEWS
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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.
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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.
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The map shows states’exchange decisions.
11. 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.
13. 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.
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The image below depicts the sources of coverage of California’s previously uninsured.
16. WORKS CITED
Altman, Drew. "On Medicaid Expansion, Red States Will Be Watching Red States." The Wall Street Journal. N.p., 30 June 2014. Web. 29 July 2014. <http://blogs.wsj.com/washwire/2014/06/30/on-medicaid-expansion-red-states-will-
be-watching-red-states/>.
Artiga, Samantha, and Robin Rudowitz. "Medicaid Enrollment Under the Affordable Care Act: Understanding the Numbers." The Henry J. Kaiser Family Foundation. N.p., 29 Jan. 2014. Web. 15 July 2014. <http://kff.org/health-
reform/issue-brief/medicaid-enrollment-under-the-affordable-care-act-understanding-the-numbers/>.
"Characteristics of Uninsured Adults Newly Eligible for Medicaid Under the ACA with Incomes Below 138% FPL, for the Nation (Number's in 1000's)." The Urban Institute Research of Record. N.p., n.d. Web. 29 July 2014. <http://
www.urban.org/UploadedPDF/412630-opting-in-medicaid.pdf>.
"Characteristics of Uninsured Adults with Incomes Below 138% of FPL by Medicaid Eligibility Status, for the Nation (Number's in 1000's)." The Urban Institute Research of Record. N.p., n.d. Web. 29 July 2014. <http://
www.urban.org/UploadedPDF/412630-opting-in-medicaid.pdf>.
"Current Eligibility Among Uninsured Adults in Non-Expansion States Who Would be Eligible for Medicaid if Their States Expanded." The Henry J. Kaiser Family Foundation. N.p., n.d. Web. 29 July 2014. <http://
kaiserfamilyfoundation.files.wordpress.com/2014/04/8585-figure-2.png?w=735&h=551&crop=1>.
"Eligibility for Coverage Among Currently Uninsured Nonelderly Individuals Currently and if All States Expanded Medicaid." The Henry J. Kaiser Family Foundation. N.p., n.d. Web. 29 July 2014. <http://
kaiserfamilyfoundation.files.wordpress.com/2014/04/8585-figure-3.png?w=735&h=551&crop=1>.
"Exchange Decisions." The Washington Post. N.p., n.d. Web. 29 July 2014. <http://img.washingtonpost.com/blogs/wonkblog/files/2013/02/final-exchange-map.png>.
Krugman, Paul. "Stealth Single Payer." The New York Times. N.p., 30 July 2014. Web. 30 July 2014. <http://krugman.blogs.nytimes.com/2014/07/30/stealth-single-payer/>.
"Medicaid and Its Role in State/Federal Budgets and Health Reform: A Fact Sheet." The Henry J. Kaiser Family Foundation. N.p., 17 Apr. 2013. Web. 29 July 2014. <http://kaiserfamilyfoundation.files.wordpress.com/
2012/05/8139-03.pdf>.
"The Role of Medicaid in State Economies Looking Forward to the ACA." The Henry J. Kaiser Family Foundation. N.p., 25 Nov. 2013. Web. 29 July 2014. <http://kaiserfamilyfoundation.files.wordpress.com/2013/11/8522-the-role-
of-medicaid-in-state-economies-looking-forward-to-the-aca.pdf>.
Sanger-Katz, Margot. "Newest Health Insurance Customers Are Generally Happy." New York Times. N.p., 10 Jul 2014. Web. 14 July 2014. <http://mobile.nytimes.com/2014/07/11/upshot/newest-health-insurance-customers-are-
generally-happy.html?referrer=&_r=2>.
"Sources of Coverage Among California's Previously Uninsured." Kaiser Health News. N.p., 30 July 2014. Web. 30 July 2014. <http://www.kaiserhealthnews.org/~/media/Images/KHN%20Features/2014/July/28%201/FINAL%20CA
%20SURVEY512.png>.
Summers, Dana. "Duking it out for Medicaid." The Week. N.p., n.d. Web. 31 July
2014. <http://theweek.com/cartoons/index/214350/
duking-it-out-for-medicaid>.
"State health exchanges by party affiliation of governor." The Washington Post. N.p., n.d. Web. 29 July 2014. <http://img.washingtonpost.com/blogs/wonkblog/files/2013/02/exchanges-by-party.png>.
"Where are States Today? Medicaid and CHIP Eligibility Levels for Children and Non-Disabled Adults as of April 1, 2014." The Henry J. Kaiser Family Foundation. N.p., 11 June 2014. Web. 29 July 2014. <http://kff.org/medicaid/
fact-sheet/where-are-states-today-medicaid-and-chip/>.
