The State Debate of Expanding Medicaid

The Affordable Care Act will expand Medicaid eligibility starting in 2014, but a Supreme Court ruling that there will be no penalty for those states refusing to comply, or who later withdraw from the program, has left many state legislators questioning how to proceed.

The expansion of the Medicaid program continues to be a topic of heated debate for many states. The Affordable Care Act will expand Medicaid eligibility starting in 2014, but a Supreme Court ruling that there will be no penalty for those states refusing to comply, or who later withdraw from the program, has left many state legislators questioning how to proceed. If accepted, Medicaid expansion could help cover up to 11 million Americans by 2022

For Illinois State Governor Pat Quinn, signing the Medicaid expansion into law seemed like common sense. "Some would call it Obamacare. I call it 'I Do Care,'" Gov. Quinn said. "It's not a privilege to have decent health care; it's a fundamental right."

The expansion of Medicaid expansion will extend coverage to a larger group of low-income adults, who make up to 138% of the federal poverty level, or about $15,000 each year, and would include those adults who do not have children at home. For Illinois, that additional coverage will include an estimated 342,000 enrolled residents by 2017.

Health officials in New Hampshire also recently discussed expanding Medicare in their state. An extension of benefits would cover almost 50,000 more poor adults, and save $46 million by 2020. However, New Hampshire State Senator Nancy Stiles expressed concern as to whether or not they would be subjected to a federal penalty if state leaders decided to later withdraw from the expansion program. In addition, State Representative Neal Kurk said the expansion would cover a negligible additional percentage of the uninsured in New Hampshire.

New Hampshite State Medicaid Director Katie Dunn could only argue that the state should not look at the issue solely in terms of percentages, rather, she felt legislators needed to look at the issue from a more “humanistic perspective.” Too many uninsured continue to receive care in hospital emergency rooms, and they often deal with chronic conditions that are left untreated.

In West Virginia, approved expansion has raised more questions, than given answers.

"I live in rural West Virginia, and I know how long it takes to see a doctor," West Virginia Delegate Denise Campbell said. "They do limit the amount of Medicaid patients that they do take... I, in my heart of hearts, really feel like we're going to have a provider issue here. Are these people going to be able to have access? Are there going to be enough providers to provide the service?"

West Virginia Senator Evan Jenkins also worried about the state’s decision wondering how it, among other provisions like individual mandate, would affect insurance premiums for young healthy adults. "A provider may say, 'I take Medicaid,' but the question is, what is the breadth of that taking?" Sen. Jenkins stated.

Nevertheless, for states like West Virginia that rank near bottom in obesity, heart disease, diabetes, and other conditions, expanding Medicaid will do more than reduce the number of uninsured people; It will improve healthcare outcomes, and ease the financial burden often placed on hospitals.

Around the Web

ACA Basics and Background [APHA]

Ill. Governor Signs Medicaid Expansion into Law [Yahoo!]

NH Officials: Expanding Medicaid Could Save $46M [Bloomberg]

Some W.Va. Lawmakers Wary of Expanding Medicaid [Bloomberg]