Thursday, July 17, 2014

Medicaid Expansion: Real People, Real Lives, Real Injuries. Information Bulletin # 395 (7/2014). Too often, advocates get bogged down with “policy” formulations and do not focus on the people who are affected by these policies. Here is what is at stake for non-elderly people with incomes below 133% of the poverty level in the 24 States that have not opted to receive 100% federal reimbursement for Medicaid expansion since January 1, 2014. Chart #1 below lists the 24 States. On July 2, the White House Council of Economic Advisers (CEA) issued a report, Missed Opportunities: the Consequences of State Decisions Not to Expand Medicaid, which details the impact of states’ decisions to not expand Medicaid under the Affordable Care Act. We are talking about a lot of people whose health care needs are put at risk because the 24 States have refused to expand Medicaid: 1. Preventive health care will not occur each year - a. for 214,000 women between the ages of 50 and 64 who would have received mammograms; b. for 345,000 women who would have received pap smears, and c. for 829,000 men and women who would have received cholesterol-level screenings. 2. Also, 651,000 people who would have received “all needed care” they felt they needed during the year. 3. If Medicaid had been expanded in every State, an additional 1.4 million people would likely have had a primary care visit at a physician’s office. See Chart #2 below for a breakdown by State. Real people, real lives, real injuries. Becausee these 24 States have not accepted Medicaid expansion, 255,000 people risked facing catastrophic out-of-pocket medical expenses which would have otherwise been covered with Medicaid. Even without catastrophic medical expenses, there would have been 810,000 fewer people who had trouble paying rent and utilities because they had to pay for medical bills. Medicaid expansion thus helps people to have greater financial security in addition to improved access to health care. Finally, in addition to individuals receiving health care, let’s not forget the impact on your States’ economies because your State has opted not to have Medicaid expansion. The impact on State economies is stark: those 24 States that have not expanded since July 1, 2014 will lose $88 million in Federal payments through calendar year 2016. Those 26 States that have expanded will receive $84 million over that period. Because Medicaid expansion is funded through our federal taxes, tax-payers in the 24 States that have not opted to expand Medicaid are subsidizing the 26 States that have expanded. The federal government pays 100% of the health costs for Medicaid expansion for three years – 2014 through 2016. Thereafter, the federal government pays about 90%. It is really hard to believe and understand why any State would not accept 100% federal funds for health care for the lowest income people, other than a real enmity toward low-income people, especially when a State could opt out of Medicaid expansion for whatever reason. Advocates in the 24 States that have not expanded Medicaid should think about whether your State accepts federal highway and other infra-structure funds for bridge repairs. We bet none of these 24 States turn down those funds. Does your State turn down federal special education funds? Maybe we should not mention food stamps for fear that the apparent hatred toward low-income people would be extended to those federal funds too. Chart # 1 - Number of people denied health care in States without Medicaid xpansion Alabama 235,000 Alaska 26,000 Florida 848,000 Georgia 478.000 Idaho 55,000 Indiana 262,000 Kansas 100,000 Louisiana 265,000 Maine 28,000 Mississippi 165,000 Missouri 253,000 Montana 38,000 Nebraska 48,000 North Carolina 377,000 Oklahoma 123,000 Pennsylvania 305,000 South Carolina 198,000 South Dakota 26,000 Tennessee 234,000 Texas 1,208,000 Utah 74,000 Virginia 210,000 Wisconsin 120,000 Wyoming 16,000 Chart #2 States Without Medicaid Expansion and People who gave had No Mammograms No Pap Smears No Cholesterol Screening In Past 12 months In Past 12 Months In Past 12 Months Alabama 9,300 14,200 34,200 Alaska 900 1,500 3,800 Florida 35,300 52,000 123,000 Georgia 17,000 28,900 69,600 Idaho 2,300 3,300 8,000 Indiana 9,000 15,200 38,200 Kansas 3,100 5,800 14,600 Louisiana 10,400 16,000 38,600 Maine 1,300 1,700 4,100 Mississippi 6,200 9,700 24,000 Missouri 9,400 14,900 36,900 Montana 1,600 2,400 5,500 Nebraska 1,600 2,900 7,000 North Carolina 13,900 23,000 54,900 Oklahoma 4,800 7,300 17,900 Pennsylvania 11,100 17,600 44,400 South Carolina 8,000 12,000 28,800 South Dakota 900 1,500 3,800 Tennessee 9,500 14,000 34,100 Texas 44,100 75,200 176,000 Utah 1,900 4,500 10,800 Virginia 8,000 1,300 30,600 Wisconsin 3,800 6,700 17,500 Wyoming 700 1,100 2,300 Real people, real lives, real injuries. Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins posted after 10/2013 can be found only at Information Bulletins before 10/2013 are available online at with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to or call 215-627-7100. Ext 227.

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