Under the Affordable Care Act (ACA), sometimes known as Obamacare, Medicaid expansion has emerged as a crucial political issue.
The Supreme Court decided in 2012 to defer to state authority on whether to approve the ACA’s expansion. Ten states still haven’t extended Medicaid in the ensuing ten years. That corresponds to more than 2 million people living in a “coverage gap” brought on by the Supreme Court’s ruling.
The gap occurs as follows: A person cannot earn more than 138% of the federal poverty level, which is presently $20,120, in order to be eligible for Medicaid. That, however, only applies to the ACA’s expansion. The Affordable Care Act’s income cutoff for subsidies under conventional insurance plans is incomes that are greater than 100% of the federal poverty line.
The result has been that those 2 million+ people are now living in poverty and are also ineligible for financial aid.
Sherry Glied, dean and professor at the Robert F. Wagner Graduate School of Public Service at New York University, told Yahoo Finance, “The plight of these people — it’s just terrible.” Imagine living in a place where it is legal to work an additional 10 hours per week, but if you do, your health insurance coverage will be terminated. That is absurd.
The article, cowritten by Glied, emphasises how most of the people in the coverage gap are people of colour and residents of the South, which is home to the bulk of the non-expansion states. The size of the Black population in a state has been linked to whether or not that state will extend Medicaid, according to earlier studies. States with disproportionately big Black populations haven’t, according to Glied.
Because they have no other options, “this is a particularly disadvantaged population,” Glied added. “They have no access to health insurance. They are unable to get health insurance on the open market. They lack sufficient funds and are ineligible for Medicaid. And this is the “gap population,” as they are known.
The article, cowritten by Glied, emphasises how most of the people in the coverage gap are people of colour and residents of the South, which is home to the bulk of the non-expansion states. The size of the Black population in a state has been linked to whether or not that state will extend Medicaid, according to earlier studies. States with disproportionately big Black populations haven’t, according to Glied.
Because they have no other options, “this is a particularly disadvantaged population,” Glied added. “They have no access to health insurance. They are unable to get health insurance on the open market. They lack sufficient funds and are ineligible for Medicaid. And this is the “gap population,” as they are known.
Having more coverage means that fewer people put off getting medical treatment because of the cost. Additionally, it increased the frequency of routine checks and interactions with primary care doctors.
The survey also discovered that improved availability and affordability of preventative care resulted in greater adoption of these services. For instance, the report found that people were 6.7% more likely to have had a mammogram than parents, who were 2.8% more likely to receive a flu shot. People in states that have undergone expansion were 1.9% more likely to use medication for high blood pressure.
Many state governments are still opposed to expanding Medicaid, despite studies showing that access to preventative care can assist with finances; Glied blames this resistance to partisanship.
Voters are now debating the Medicaid expansion proposal on the ballot. Voters just strongly supported expansion in conservative areas like Arkansas and Nebraska. Ten states with Republican governors in charge have kept the programme from receiving federal cash.
According to Glied, it may merely take additional time for more states to completely accredit.
State legislators will soon realise that the Affordable Care Act is here to stay and that their constituents pay federal taxes that are used to finance Medicaid expansion in states like California, New York, Massachusetts, and other places they don’t particularly like, but not in their own, predicted Glied.
After the Families First Coronavirus Response Act, a pandemic-era statute that established continuous enrollment in Medicaid in all states, expires, obtaining coverage could become even more difficult. The last day of that programme was March 31, 2023.
For instance, Glied stated, “If you live in Texas and your income dropped below the cutoff, you will now be expelled. Therefore, when the continuous coverage provision expires in the non-expansion states, a significant portion of those individuals will lose their insurance, in contrast to how few we anticipate in the expansion states.
According to data, Medicaid expansion increases insured rates by virtually doubling them in every racial demographic. The “challenging conundrum” for the Biden administration, according to Glied, is that it is already covering a large portion of the costs associated with Medicaid expansion, and Republican governors are unlikely to give in politically.
What to do to entice these states that declined this excellent offer is a serious concern, Glied added. Want to extend your offer to them further? That doesn’t seem really fair or right. Therefore, if their states don’t want to provide coverage, there is a difficult quandary to solve.