Economic Impact of States Declining Medicaid Expansion
Recall that Medicaid is a joint federal and state entitlement health insurance program. The ACA of 2010 required all states to eliminate the use of categories to determine eligibility and expand the Medicaid program to all persons younger than age 65 with incomes at or below 138% of the federal poverty level. However, in June 2012, the U.S. Supreme Court ruled that requiring states to expand their Medicaid programs was unconstitutional: Each state could make its own decision on whether to expand the program. By 2016, 32 states and Washington, D.C., had opted to expand their Medicaid programs. Declining expansion means that Medicaid continues as it was prior to the ACA’s implementation, with category- based eligibility.
Discussion Points
1. Determine whether your state has expanded its Medicaid program.
2. Explain why a very poor person (income below FPL) living in one of the states that declined Medicaid expansion may be ineligible to participate in the health insurance exchanges.
3. What is the economic effect on the state (and on the hospital or site where you work or are being trained) of having a large population of uninsured people?
4. Why would a state choose not to participate in Medicaid expansion despite the federal promise of paying for the additional beneficiaries?
5. There is no “right” to health care in the U.S. Constitution. Debate the pros and cons of a universal Medicare-for-all healthcare finance program for the United States. Refer to the ANA Code of Ethics to inform your debate.
6. Refer to the following article: Sommers, B. D., Gourevitch, R., Maylone, B., Blendon, R., & Epstein, A. M. (2016, October). Insurance churning rates for low income adults under health reform: Lower than expected but still harmful for many. Health Affairs, 35(10), 1816–1824. Answer the following questions: In terms of health insurance, what is “churning”? What effect does churning have on access to care and quality of care? What is the relationship among access to care, quality of care, and cost of care?
References
Anderson, J. L., Heidenreich, P. A., Barnett, P. G., Creager, M. A., Fonarow, G. C., Gibbons, R. J., . . . Shaw, L. J. (2014, March 27). ACC/AHA statement on cost/value methodology in clinical practice guidelines and performance measures: A report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and Task Force on Practice Guidelines. Circulation. Retrieved from http://circ.ahajournals.org/lookup /doi/10.1161/CIR.0000000000000042 Assistant Secretary of Planning and Evaluation. (2016, October 24). Research brief: Health plan choice and premiums in the 2017 health insurance marketplace. U.S. Department of Health and Human Services. Retrieved from https://aspe.hhs.
