Posts Tagged ‘Medicaid Expansion’

Republicans ready to kill Medicaid expansion

June 13, 2017

I hadn’t realized that more Americans are enrolled in Medicaid, the health-insurance program for low-income Americans, than in Social Security, Medicare or any other federal benefits program.

And the increase in the number of Americans with health insurance under Obamacare—the Affordable Care Act—is due more to the expansion of Medicaid than to signups of people under the health insurance exchanges.

But Senate and House Republicans have reportedly agreed on a plan to dial back the Medicaid expansion.

Kevin Drum of Mother Jones reported that there are 68 million Medicaid enrollees, making it a bigger program than Social Security (61 million), Medicare (55 million), food stamps (44 million), unemployment insurance (6 million at the height of the recession), the earned income tax credit (26 million) and temporary aid to needy families (about 4 million).

Medicaid was created to provide health insurance for Americans earning poverty-level wages.   Under Obamacare, eligibility was increased to Americans earning 138 percent of a poverty wage.  This would be $16,394 for an adult, according to CNBC News.

The program is administered by state governments.   President Obama’s plan pays states nearly all the costs added by the expanded plan, and then a progressively lesser amount sliding down to 90 percent.  The Supreme Court ruled that state governments cannot be compelled to accept the expanded plan, and 19 state governments, all with Republican governors, opted out.

CNBC reporter Dan Mangan reported that Medicaid has added 15 million enrollees since Obamacare went into effect, a figure which includes some people who would have been eligible under the old rules.   That’s nearly 4 million more than signed up for health insurance under the Obamacare exchanges.


States block health insurance for millions of poor

October 4, 2013

Double click to enlarge

The New York Times reported that, thanks to the Supreme Court’s Medicaid loophole and the actions of the governments of 26 mostly Southern states, millions of poor people will be excluded from Obamacare.  The article said:

A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.

Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help.  The federal government will pay for the expansion through 2016 and no less than 90 percent of costs in later years.

Those excluded will be stranded without insurance, stuck between people with slightly higher incomes who will qualify for federal subsidies on the new health exchanges that went live this week, and those who are poor enough to qualify for Medicaid in its current form, which has income ceilings as low as $11 a day in some states.


The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers.  About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides.


Barry Ritholtz on The Big Picture provided this map showing the overlap between those who want to block health insurance for poor people and those who want to shut down the government.


Double click to enlarge


The coming battle over Medicaid

July 8, 2012

Chief Justice John Roberts handed backers of Obamacare a time bomb in the part of the court decision affecting Medicaid.  The whole point of the Affordable Care Act is to provide health insurance to people who can’t afford to pay for it.  Expansion of Medicaid coverage of people above the poverty line is an important part of expanding health insurance coverage, and one of the things that made Obamacare palatable to liberals.  But Chief Justice Roberts rules that state governments can refuse to expand Medicaid coverage if they wish, and still keep existing Medicaid subsidies.

A number of state governors—all Republicans—have said they’ll exercise their right to refuse to expand Medicaid.  I’m in favor of expanding Medicaid, and I wish I could say that this is nothing more than blind partisanship or contempt for the poor.  Unfortunately, there are objective reasons why a state governor might be dubious about expanding Medicaid.

The good folks at Think Progress point out that, under the Affordable Care Act, the federal government will pay 100 percent of the cost of Medicaid expansion for the first two years, and 90 percent for the next five years.  But what happens after seven years?  This is how the federal government has always induced state and local governments to adopt federal programs—offer subsidies that are too enticing to refuse, then gradually pull back after the program has created a local constituency to advocate for it.

Unfunded federal mandates are a big program for state and local governments, and unfunded state mandates are a big problem—I don’t think New York state is alone in this—for state governments.  The growing cost of Medicaid, unlike Social Security and Medicare, is a big problem.  Part of the practice of my lawyer friend DH is to help middle class retirees gradually give away their wealth to their loved ones so that they can qualify for Medicaid in their declining years.  I don’t blame people who want to leave an inheritance rather than have it all eaten up by medical bills, but this isn’t the purpose of Medicaid.

The Obama administration claims there are cost-saving measures that will limit the increase in Medicaid.  Fewer people will go to hospital emergency rooms for routine medical care, for example.  Maybe so and maybe not—the answer is not obvious.  What was obvious from the start was that the complexity of the Affordable Care Act, and the slow timetable for putting it into effect, was sure to guarantee an ongoing struggle.

Click on GOP Governors May Turn Down $258 Billion in Obamacare Funds, Leave 9.2 Million Americans Uninsured for analysis by Think Progress and the source of the map and chart above.

Click on GOP governors may be shafting their own states and constituents for an argument by Greg Sargent of the Washington Post that the Affordable Care Act will actually save states money.  The problem with his argument is that they’ll get the benefit of these savings whether Medicaid is expanded or not.

Click on The Obamacare Tax on the Middle Class for an argument by James Kwak on Baseline Scenario that most Americans will not be affected by the Affordable Care Act and that most of those who are affected will pay less for health coverage.

Click on The Dems who might fight “Obamacare” for speculation by Steve Kornacki of Slate about Democratic governors who might refuse Medicaid expansion.

Click on Are Federal-State Grant Programs “Progressive”? for thoughts of Ed Kilgore on the Washington Monthly’s Political Animal blog.  [Added 7/10/12]