It’s no surprise that politics are being played with Medicaid.
As we have discussed before, there is a history of playing politics with Medicaid. This is nothing new; however, subsequent to the Supreme Court Decision last week, we are about to see some of these politics to the next level.
Take for example Texas.
Governor Rick Perry has decided for the state of Texas will not be expanding Medicaid in Texas nor create a state health insurance exchange. Despite having 4,886,100 people uninsured (33% of the Texas population), the Governor has decided against the option the federal government proposed through the Patient Protection and Affordable Care Act.
But first, what do we know about the Medicaid expansion?
After last weeks Supreme Court decision, states now have the option of expanding Medicaid based by changing enrollment requirements based on their best guess as to what may work. In the expansion, folks 133 % above the federal poverty line qualify for increasing coverage. Essentially this means that 17 million individual who are now currently uninsured gain Medicaid coverage.
Further, “after three years, the individual states participating in the Medicaid expansion may sustain costs from this extension. The federal government will not pay all bills for Medicaid enrollees who qualify for the program, but who haven’t registered. If individual states choose not to expand Medicaid coverage to their residents, this decision could lead to fewer people with access to care and more state residents subject to the ACA’s mandate requiring individuals to purchase health insurance or pay a tax, as opposed to being eligible for Medicaid under the new federal requirements.”
This matters. In fact, health insurance in general matters.
So what do we do about the uninsured? What do we do about those who cannot afford health insurance and whose states are not expanding Medicaid nor setting up Health Insurance Exchanges (HIE)?
Well what is clear is that we have to do something. Regardless of the politics that are being played here around healthcare, states are going to have to get serious about the uninsured.
“A substantial body of research shows that there are serious health and financial consequences associated with being uninsured. Moreover, research shows that leaving a large share of the population without health insurance affects not only those who are uninsured, but also the health and economic well being of the nation.”
In 2004, uncompensated care was estimated to be $40.7 billion. Adults (18+) predominately receive uncompensated care totaling $26.3 billion or 65% of the total amount. This $40.7 billion does not just disappear because the individuals receiving this care cannot pay for it, but rather these costs are put back on the system and the taxpayer; basically, everyone pays.
However, controlling for politics just for a second, let’s consider that even if all states expanded Medicaid and introduced Health Insurance Exchanges would that address the underlying increase in healthcare cost?
Consider what Peter Orszag wrote for the New England Journal of Medicine:
“One approach that could reduce total healthcare spending (rather than simply reallocating it among different sectors of the economy) involves generating more information about the relative effectiveness of medical treatments and enhancing the incentives for providers to supply, and consumers to demand, effective care.”
We know that our current system encourages more and more complex services to be provided (whether or not those services are necessarily the best or most appropriate care). This is in part because of how we pay our providers (fee for service whether or not it works or not). So Orszag has got this one right – we must start to examine what procedures at what cost lead to the most improved outcomes. More is not always better.
More and more states will be speaking out against Medicaid expansion in an attempt to take an ideological stand against what they see as “Obamacare” in their states.
Politics will trump coverage for some patients and families. It goes without saying that this is unacceptable.
While the current plan for Medicaid expansion and HIE still may have some kinks that need to be ironed out, there are people out there who could benefit now from insurance coverage. We must start to move to help those who often need healthcare the most.
Will we allow politics to trump what is right? Will we site idly by as our states make decisions for thousands of people regarding healthcare?
We must be informed;
We must speak out and take action; and,
We must push for transformation.
Get used to politics and Medicaid – this one is not going away anytime soon.