Spotlight Exclusives

Health Reform۪s Medicaid Expansion: Politics vs. Progress

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Although the Affordable Care Act۪s (ACA) new health exchanges have dominated the news cycle, the expansion of an existing program, Medicaid, is equally central to the law. Of the 30 million previously uninsured Americans who were expected to receive coverage through the ACA in 2016, nearly 17 million would do so through the Medicaid expansion. At least they would have if the law were implemented as intended. Unfortunately, by declining the Medicaid expansion, which the Supreme Court made optional, many states are putting politics ahead of the well-being of people.

Created in 1965 to provide healthcare for the poor, Medicaid has since served as a lifeline for millions. The vision underlying both Medicaid and the Medicare program was a desire to create a more equitable health system that could provide high-quality care to the country۪s underserved.

Yet, nearly 60 years after the birth of the Civil Rights movement, our country is still plagued by healthcare disparities and inequities. The ACA was designed to take the next step toward true health equity by expanding Medicaid and offering Americans affordable private insurance options.

That vision, though, is in jeopardy. In its original form, the ACA۪s Medicaid expansion would have covered up to 17 million low-income adultsmaking a significant dent in our appallingly high uninsured rate. Because of the Supreme Court۪s 2012 ruling, however, many governors and legislators opted out of the expansion, despite the modest cost to states.

So far, 25 states as well as Washington, D.C. are expanding their Medicaid programs. If the remaining states do not get on board, over five million people will be left out. These states are home to many of the most marginalized Americans including “68 percent of poor, uninsured blacks and single mothers” according to an October 2013 New York Times piece. They are caught in a catch-22 that was never intended: too poor to qualify for financial help in the marketplace, but not poor enough for traditional Medicaid. The result: these struggling adults will remain uninsured with no end in sight.

The human and economic plight of the uninsured is well-documented. The effects span the physical, mental, and economic. Racial and ethnic minorities are particularly hurt. Compared to whites, they are disproportionately uninsured and suffer higher rates of preventable chronic diseases.

It does not have to be this way. A recent study published in the New England Journal of Medicine found previous Medicaid expansions in Arizona, New York, and Maine generated a “significant” reduction in mortality, less delayed care, and individuals reporting they were in “excellent” or “very good” health. Fully expanding Medicaid would mean working adults living paycheck to paycheck wouldn۪t have to put off needed medical care until an emergency arises and wouldn۪t have to live with the day-to-day uncertainty that comes with being uninsured.

Politics, as was the case in the 1960s, however, firmly stands in the way. Recalcitrant governors have blamed much of their reluctance on cost. But, their math does not add up.

Without an expansion, health costs for the uninsured will not simply disappear. State and local governments already pay a staggering 30 percent of uncompensated care. The ACA cuts Medicare۪s and Medicaid۪s payments to some hospitals, a loss that expanding Medicaid eligibility was supposed to offset. And the federal government will cover the full cost of state Medicaid expansion over the first three years, and at least 90 percent of the costs thereafter.

This is why 11 Republican governors have put the health and welfare of their citizens first by either authorizing some form of the expansion or signaling their support for doing so. When Florida Governor Rick Scott, one of the staunchest of the anti-ACA lot, announced his support for the Medicaid expansion, his reason was simple: “While the federal government is committed to paying 100 percent of the cost of new people in Medicaid, I cannot, in good conscience, deny the uninsured access to care.” For fiscal conservatives, it۪s a position that fits.

To leave $35 billion on the table, however, in the remaining states, is unconscionable, particularly when the “no expansion” camp include the nation۪s top 10 poorest, including legacy Jim Crow states South Carolina, Louisiana, Alabama, and Mississippi, along with Oklahoma. The most low-income and vulnerable in these states will lose out on the most basic of services like cancer screenings, life-saving diabetes treatment and, in short, the ability to stay healthy and self-sufficient.  

This year will bring new hope to millions of Americans as they realize they no longer have to live in fear of what may happen if they get sick. For the over five million who will be left out, however, this is merely an illusion.

It۪s time these governors and legislators put their people first.

To print a PDF version of this document, click here.

Kathy Ko Chin is president and chief executive officer of the Asian & Pacific Islander American Health Forum.

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