Medicaid Expansion: Challenges with Health Care Reform

Medicaid Expansion: It is still very early in the implementation of the Affordable Care Act. The private exchange is schedule to go live January 1, 2014, We all are waiting to hear the decision each state will make with regards to; their Health Insurance Exchange Structure, as well as whether they will expand their state Medicaid plan. As the results come in were starting to see some impeding challenges that may lie ahead for the Law, States, and the Poor.


One of the founding structures of The Affordable Care Act is to ensure everyone has Health Insurance, especially the very poor individuals. This goals was meant to be done through the expansion of Medicaid by the states, while the Supreme Court provided the Affordable Care Act a huge victory it also provided the state with the option to turn down the Medicaid expansion option. Medicaid is handled on a State level, not a federal level. The federal government can simply ask a state to make changes to their Medicaid structure, and provide incentives, but can’t force them.


The Health Insurance Tax, slated to start in 2014 for those that do not have health insurance is targeted as a motivator to buy health insurance or face a penalty, but many of the poorest individual will not be able to afford Health Insurance, very similar to today and the subsidies starts at $11,170 more than the poverty level. This now leaves holes that must be patched to support the very poor that are living in States that have declined to expand Medicaid


Currently there are 9 states led by republican governors that are choosing not to setup their own exchange or expand Medicaid. These states are Arizona, Alabama, Georgia, Louisiana, Maine, Mississippi, Oklahoma, South Carolina, and Texas. In some cases these states are being pushed on both sides who have a stake in their decisions. Conservative peers are pushing these States to turn down the Medicaid options, while Hospitals, Doctors and the poor are pushing them to accept it. The hospitals are heavily invested in this, many hospitals agreed to Medicare cuts in the Affordable Care Act, with the hope, they would net out through the expansion of Medicaid.  The states has said previously they don’t want to get stuck with the bill for expanding Medicaid, contradictory to documents and federal statements, that the federal government will cover 100% of the cost of new members up to 2016, and after that they will cover around 90% of the cost.


At this point I am not sure if it’s political or if States are standing on the sideline to watch what comes of the Fiscal Cliff issues? In any situation I think States choosing to not expand Medicaid still leaves the unanswered question on how do we provide and support the poorest in our nation with adequate healthcare to prevent them from going to the emergency room, and all of us paying for it.


According to a  new study by the Henry J. Kaiser Family Foundation and the Urban Institute, states fully implementing Obamacare’s Medicaid expansion would result in an additional 21.3 million Americans on insurance rolls while raising states’ Medicaid spending by less than three percent. The Huffington Post states :

“The total cost of the Medicaid expansion would be $1.03 trillion between 2013 and 2022, according to the study. States would pay $76 billion of that, which amounts to a 2.9 percent increase compared to what states would have spent on Medicaid if the health care reform law hadn’t been enacted.”

Additionally: “In addition to receiving a large federal subsidy to enroll these uninsured residents, states that expand Medicaid would be able to reduce spending on taxpayer-funded programs to help hospitals and other health care providers cover the cost of so-called uncompensated care, or unpaid medical bills. If Medicaid expanded across the country, states would save $18 billion between 2013 to 2022, according to the study.”


Medicaid Expansion is very similar to anything that involves larges sums of money, there will always be key players. The players in the Medicaid expansion fight includes; Hospitals, Lobbyist, Federal Government and politicians. The States continue to say they don’t want to get stuck with the bills, but who is currently covering the uninsured? One thing we have to remember, extending coverage to previously uninsured Americans will help improve their quality of life and prevent states from absorbing their unpaid medical bills, it should not be a political football where we are willing to let the less fortunate suffer, because of politician whose only goal in life is to make it to another term in their respective offices.

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