Will they or won’t they? Examining state Medicaid expansion
In June 2012, the Supreme Court ruled that Obamacare’s mandated Medicaid expansion for low-income Americans should be optional for states. Since then, health policy experts have been paying close attention to how individual states are proceeding with the rollout of national health reform.
As of midsummer, roughly half the states were planning to join the initial Medicaid rollout. States that opt in to the expanded program—which would cover everyone with incomes below 133% of the federal poverty level including childless adults for the first time—would have their expansion completely funded by the federal government for three years. Over time, the federal contribution would decrease to 90%.
McDonough, director of HSPH’s Center for Public Health Leadership and an architect of Massachusetts’ health insurance reform—which served as a template for Obama’s Affordable Care Act (ACA)—said that the Medicaid expansion outlined in the ACA is aimed at standardizing eligibility across the nation. Currently, he explained, states vary widely in how much Medicaid they provide their citizens.
“A lot of governors and state legislatures around the country over many years have controlled the rate of growth of their Medicaid programs by making it as difficult as possible for people to enroll in Medicaid or stay in Medicaid once they’ve been enrolled,” he said. “So they manage their program budgets by continually bouncing out as many people as they can and keeping as many people out as they possibly can.”
Said Sommers, assistant professor of health policy and economics in the Department of Health Policy and Management, “The majority of people have the mistaken perception that Medicaid is available to all poor Americans. But if you aren’t in one of those traditional eligibility groups—if you’re not a parent, a child, or someone with a disability—it doesn’t matter how poor you are, you’re not eligible in most states.”
He added, “This is a major opportunity now for a large number of low-income adults, many of whom work and simply can’t afford private insurance, to have another option. But that will hinge on what individual states decide to do.”
Podcast: The Supreme Court’s decision on the Affordable Care Act (HSPH multimedia)