Medicaid Expansion is a Win-Win: More Health Care for more people (at Less Cost!)
One of the key ways in which the Affordable Care Act (ACA) is expected to provide health care to millions is through the expansion of the Medicaid program.
As passed by Congress, the ACA guaranteed that all people with incomes below 138% of the federal poverty level would have access to Medicaid coverage. But, even in its historic decision to uphold the law, the Supreme Court ruled in June that states had the option to decide whether or not people in their state would have access to this coverage. And this is where the politics is coming in…
Nationwide, Medicaid covers health care services for 1 in 10 women, serving more than one in five women with incomes below 200 percent below the poverty line. Nearly half of Planned Parenthood patients rely on Medicaid coverage to access affordable, preventive care, including lifesaving cancer screenings and birth control. For millions of women, Medicaid makes the difference between getting access to cancer screenings and birth control, or going without. With the Medicaid expansion, an estimated 8 million additional women of reproductive age will become newly eligible for coverage.
Expanding Medicaid as part of health care reform is also a sound fiscal decision for states. The federal government will finance the full cost of covering newly eligible individuals in the Medicaid program for the first three years, and gradually decreasing the amount to 90% starting in 2020. This means that a state that expands its Medicaid program will not have to pay anything for the first three years – after that, the state will pay only a fraction of the costs to cover newly eligible individuals. In addition, expanding coverage would ultimately lower health care costs, helping states save money in the long run. Wells Fargo characterized the Medicaid expansion as “too good to pass up” considering the state savings and generous federal match.
So why are a number of states rejecting the option to expand their Medicaid programs under the Affordable Care Act?
That is the question that so many health policy, financial, and health care advocacy groups are asking (Planned Parenthood Action Fund included!) A number of conservative governors are choosing ideology over the health of their own citizens and their budgets by rejecting expansion of the Medicaid program.
The worst of the worst has to be Texas Governor Rick Perry. Perry is citing the cost of expansion as the reason for refusal, but as many research groups have identified, the long run savings far outweigh the short term costs. The Urban Institute estimates that states will save between $26 and $52 billion from 2014 to 2019, and the Lewin Group estimates state and local savings of $101 billion in uncompensated care. It’s particularly maddening, because Texas has the highest rate of uninsured residents—1.5 million Texans could potentially benefit from the program that would be 100% covered by the federal government for seven years. Yet, in spite of opposition, Gov. Perry remains consistent with his July statement that, "If anyone was in doubt, we in Texas have no intention to implement so-called state exchanges or to expand Medicaid under ObamaCare."
Nevertheless, governors in states like South Carolina and Oklahoma are also on record resisting implementation. And if there’s something these states have in common (other than their out-of of-touch Governors) it’s the poor health outcomes residents already face. The Harvard School of Public Health found that states that substantially expanded Medicaid coverage to adults had a 6.1% decline in death rates in individuals ages 20-64, but evidence like this hasn’t fazed politicians, who would rather reject this program, than allow aspects of Obamacare to become a reality.
There is no sound reason why any state should deny these women and families access to basic health care coverage. Medicaid protects women’s access to family planning by ensuring coverage and giving women the ability to choose their own health care provider. Expanding Medicaid is good for women and families—and good for states. Isn’t it time states put affordable access to health care above politics?