Medicaid expansion

Millions of Americans are stuck in a health coverage gap created by the Supreme Court strucking down the Obamacare mandate that states expand Medicaid and the refusal of many states to voluntarily expand their existing Medicaid programs, The Wall Street Journal reported this week. The WSJ reports on one woman who earns $7,000 as a cleaner, which is too little to get help buying coverage on the healthcare insurance exchanges and too much to get coverage in Alabama's Medicaid program.

Twenty-four Republican-led states have declined the expansion, WSJ also reports. That might be changing in some states: "Some GOP-led states are revisiting their decision as complaints pile up over the coverage gap—and its consequences for businesses—in such states as Utah and Florida. The state senate in New Hampshire last week reached a tentative deal to expand Medicaid. In Virginia, newly elected Democratic Gov. Terry McAuliffe hopes to get legislators to reverse his Republican predecessor's stance against expansion," according to WSJ.

The Washington Post editorialized this week that Virginia should expand Medicaid because "people above and below them get help from other federal health-care provisions — and while Virginia’s citizens pay federal taxes to fund the coverage expansion but get none of those dollars back."

The Chicago Tribune reports on how a "little-known" provision in the Medicaid health-insurance expansion is going to increase the practice of the government asserting liens on patients' assets to recoup expenditures on medical costs: "The issue arises because of a provision in the long-standing laws governing Medicaid that compel states to recoup certain medical costs after a person dies, either via liens placed on an individual's home or claims on their assets." Liens are not asserted in private insurance policies bought on state-based insurance exchange.

The Tribune reports that new Medicaid patients could face liens even if they don't seek medical care: "In another twist, all new Medicaid patients in Illinois were placed into so-called managed-care programs, in which the state pays insurers on a per-member per-month basis. That means people like Rosato will be racking up health care costs even if they don't seek any medical care. In theory, that money could all come out of their estates once they die."

Some states, included Oregon and Washington, have tweaked their regulations to apply recovery efforts only to long-term care, The Tribune further reports. However, Illinois has not.

The Centers for Medicaire & Medicaid Services said it will provide guidance to states sometime soon.

The Republican governor of Utah has announced an expansion of Medicaid, Huffington Post reports. Many Republican states have resisted the expansion of Medicaid under Obamacare as too expensive. But Governor Gary Herbert "pointed to the 60,000 individuals in the state who will gain coverage under the state's expansion of the program, saying it's 'not fair' to leave them without a solution," Huffington Post further reports.

The Medicaid expansion was a key part of ensuring that lower-income Americans, including many working poor, would get health-care coverage under the new mandate that all Americans have health insurance. But the U.S. Supreme Court said that the expansion could not be mandated to the states by the federal government. That has left it up to the states on whether they'll accept federal dollars to implement the expansions.

As health-care expands in an effort to cover all Americans, the Medicaid expansion could mean that more people over the age of 55 will face liens being placed on their assets for their care, according to a report in BenefitsPro. "Washington and many other states, including California, Florida and New York, interpret the [federal] regulations to mean that they should use liens to try to recover any money spent by Medicaid on any care for people ages 55 and older, not just for long-term care specifically," BenefitsPro also reports. But regulators in Washington issued an emergency rule to limit lien recoveries only to Medicaid funds spent on long-term care in order to reduce a disincentive for people to sign up for health-care coverage, BenefitsPro concludes

After the U.S. Supreme Court ruled states could not be forced to expand their Medicaid programs for the poor as part of the Obamacare health reform law, that is leaving many of the most impoverished Americans still without health care, The New York Times reports after a detailed analysis of census data. Among its findings: "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."

On a personal note, I still have hope the states that resisted expanding Medicaid will do so in the future. I attended a health law conference last winter, and a Pennsylvania lobbyist for health care pointed out that all the states eventually adopted programs like Medicaid and Medicare, when first created, even if they resisted for several years. He also arged that healthcare providers will lobby to get the expansions in order to control their costs. This is no consolation for any one person who can't get coverage today, but it's systemic hope for the success of correcting the healthcare marketplace.

Rather than expanding Medicaid to cover more Pennsylvanians when the mandate to have health insurance kicks into effect, Pennsylvania Tom Corbett proposed yesterday that funds for the expansion instead be used to help state residents get private health insurance. The pitch will need federal approval.

When the US Supreme Court upheld the constitutionality of the insurance mandate under Congress' taxing power, the court separately rejected making the expansion of Medicaid mandatory upon the states. Some Republican governors have accepted the expansion, while others like Corbett have not.

 The Harrisburg Patriot News editorial board welcomed Corbett's efforts to expand insurance coverage for poorer Pennsylvanians but said requiring participants to look for work in exchange for coverage and imposing a modest co-pay might make the plan unworkable. Read the full piece here: http://www.pennlive.com/opinion/index.ssf/2013/09/corbett_rolls_the_dice...

In closing the board said: "The insurance gap remains one of the most pressing public policy questions of our time. The first and only priority should be closing that gap. Ideology, if it is a factor at all, should finish a distant second."