First published on the OccupyHealthcare blog, July 18 2012.
Just about three weeks ago, the Supreme Court ruled that the Patient
Protection and Affordable Care Act (ACA) was constitutional in its
requirement that all Americans have health insurance. However, the
court also decided that the ACA's expansion of Medicaid eligibility and
coverage could not be forced upon the states. States could opt to
expand Medicaid as the law required, but those states that choose not to
expand would not face the loss of their current Medicaid funding.
Already, a number of Governors have declared their opposition to this Medicaid expansion.
ACA's expansion of Medicaid is an important part of the law's efforts
to expand coverage and healthcare access to most Americans. The law
would require the expansion of Medicaid
to cover individuals up to 133% of the Federal poverty level. The
Federal government will pay 100% of this expansion for the first three
years, a level of support that gradually lowers to 90% over the next
five years. It is expected that, as designed, the ACA's Medicaid
expansion would provide coverage to 17 million Americans. The law's new
health insurance exchanges, that facilitate individuals' purchase of
health insurance and provides subsidies for those with incomes between
133% and 400% Federal poverty level, would account for the rest of the
ACA's increase in health insurance coverage.
Late last week, the Republican Governors Association (RGA) sent the Obama Administration a letter
outlining their concerns about the proposed Medicaid expansion and the
ACA's health insurance exchanges. The letter, signed by Virginia
Governor Bob McDonnell, has one particularly notable passage:
reason this passage struck me is because of its chutzpah. The RGA's
own members are those who will make the decisions for their states as to
whether or not the state will expand Medicaid coverage. However, if
the state chooses not to, it is somehow the fault of the Administration
for not having come up with an alternative plan. The letter purports to
show concern for those low-income Americans who would have been covered
by the Medicaid expansion (if not for the Governors' decisions to
reject it), and expects the federal government to provide a means of
coverage for these low-income individuals.
Of course, the ACA does
provide a means for low-income people to access health insurance: it
expands Medicaid. The RGA's letter is absurd, essentially saying: "If
we reject the remedy you have developed to cover low-income Americans,
you must come up with an alternative." This is even more striking if
one reviews the underlying reasons why the states might reject the
Medicaid expansion: they claim it is a violation of states' rights. If
the states are worried about expansion of federal power, how is asking
the Federal government for an answer to a state's own rate of uninsured
individuals in any way logical? If anything, the states should be
fixing this problem themselves if they were following their
argument to its logical conclusion. Instead of asking for Federal help,
the states should have already addressed this issue.
that have already rejected the ACA's Medicaid expansion include Texas
and Florida. Both states are among those with the highest rates of uninsured.
is second on this list, and is also considering rejecting the Medicaid
expansion. The states whose residents would gain the most in terms of
access to health insurance are those who are fighting this increase in
access. These three states also have Republican governors, who have not
come up with a better plan to improve access to insurance as of yet.
If Republican governors truly thought that low-income Americans' access
to health insurance was a problem, they have had ample time to come up
with a solution...and they have not done so.
Medicaid coverage improves health outcomes,
with the trade-off of an initial cost increase (possibly as those who
have been insured finally access care). With the Federal government
covering 100% of the initial expansion, they (not the states) would be
paying for these up-front costs. Given that Medicaid is more
cost-effective than private insurers (point 7 on this list), expanding access to health insurance via a program that is both cost-effective and beneficial is a smart move. Meanwhile, we know that being uninsured is bad for one's health.
to the ACA, we now have the tools to expand health insurance--and
health care--to 30 million more Americans. Those who decry the law's
reforms have, for the most part, failed to act in their own states and
have failed to present a viable alternative. If the ACA's opponents
thought the issues of heath insurance and access to health care were a problem,
they would have acted long ago. It is time for them to stop
obstructing this important step forward to improve Americans' health.