The Affordable Care Act (ACA) is on pace to become, if it hasn’t already, one of the most controversial pieces of legislation of our generation.
The Supreme Court’s upholding of the individual mandate and the botched initial rollout of healthcare.gov have not only left many resentful of Obamacare but have also rendered many unable to take advantage of its potential benefits. Despite these formidable problems, there is one ACA insurance plan that is successfully enrolling millions of citizens around the country: Medicaid.
The Medicaid expansion represents a fundamental, although often overlooked, piece of the ACA strategy.
Medicaid is a health insurance program specifically targeted to low-income or disabled citizens and their families. While it is partially funded by the federal government, individual states provide up to half of the total insurance funding. This is different from the other governmental insurance program Medicare, which is federally funded in full and only available to those over the age of 65. With the ACA expansion, people up to 133% of the poverty line now qualify for Medicaid coverage. The ACA is also covering the vast majority of these expansion costs, starting with 100% coverage in 2014–2015 and dipping down to 90% coverage in 2020 and beyond.
The Medicaid expansion seems to relieve many insurance-related woes of those previously locked out of the governmental insurance plan. Many citizens below the 133% poverty level work low-wage jobs that do not offer any form of health insurance, requiring them to pay medical expenses out of pocket. Accidents and illnesses become extremely costly and stressful, as these uninsured individuals are required to pay bills they cannot cover on their own.
Furthermore, many doctors, particularly specialists, refuse to treat uninsured patients. Thus, many chronic diseases, such as diabetes, heart disease and hypertension, go fully untreated or significantly undertreated. Unsurprisingly, many of these health care costs are inevitably passed on the state as emergency rooms become the only place people can turn to for care. Therefore, this system is extremely costly for both uninsured individuals and state governments.
While the Medicaid expansion has settled in the typical partisan battle lines, the debate has taken a different form within the GOP. Many conservatives publicly disparage the expansion, yet have taken advantage of the coverage when given the opportunity. The reason is because, unlike the individual mandate, Medicaid expansion does not require a purchase by the individual; instead, individuals are given service without a direct cost. This temptation is difficult for both citizens and state legislators to resist. In fact, Medicaid usage has been equated to drug peddling by its proponents.
However, Medicaid expansion is hardly the panacea to our health care woes. Medicaid coverage is limited, and many doctors still refuse to see Medicaid patients due to low reimbursements. Furthermore, Medicaid does not address the majority of medical costs but rather shifts the cost burden to the government. In addition, health insurance alone will not address the economic, social and environmental issues that are all contributing factors to the relatively poor health of this nation. In fact, recent study from the University of Oregon has shown that, when people are suddenly granted Medicaid coverage, it is mental health, not physical health, that improves dramatically. For example, while instances of diabetes, heart disease, and obesity remain relatively constant with changing coverage, cases of depression significantly decrease with coverage. However, mental health should not be overlooked. Medicaid can provide the peace of mind to many Americans worried they cannot meet their health care costs.
