By Ashley Lopez
Florida Center for Investigative Reporting
Overall, the U.S. Supreme Court’s ruling upholding the Affordable Care Act (ACA) is good news for most Americans without health insurance. The law will expand coverage to millions of Americans who before the law had significant trouble obtaining health insurance.
However, digging deeper into the court’s decision regarding a provision that expands Medicaid, there is a very real possibility that the poorest among us might still be shortchanged.
The court ruled that the federal government could not penalize states for not expanding their Medicaid programs to more people. The proposed penalty would be for the federal government to revoke a state’s existing Medicaid funds.
The Medicaid expansion would have included everyone whose income is less than 133 percent of the federal poverty level. In the past, you had to have a disability or a child to receive Medicaid coverage, as well as have an income that is less than 133 percent of the federal poverty level.
Even though the expansion would be fully paid for by the federal government and down the road would be covered at least 90 percent by the feds, the court sided with Florida and deemed the provision “coercion.” This provided states with a way to opt out of the Medicaid expansion. Already, Gov. Rick Scott has announced that Florida would be among the states to opt out of the expansion.
As Talking Points Memo reports, this is already a trend among states that are having the most trouble insuring their poor:
But many of the states with high-profile conservative governors vowing to stand athwart the ACA’s progress, by refusing to expand their Medicaid programs and erecting hurdles to establishing insurance marketplaces, would stand to gain the most from successful implementation of the law. …
With a 21 percent uninsured rate, Florida is tied with Nevada and New Mexico for second to last place in the country. But conservative Gov. Rick Scott is vowing to opt out of a Medicaid expansion, almost fully financed by the federal government, now that the Supreme Court has ruled that the feds cannot threaten states with the loss of all their Medicaid funds for refusing to expand the program.
To add insult to injury, the ruling will also affect those who are already enrolled, by allowing states to remove existing enrollees.
This wasn’t supposed to happen under President Barack Obama’s health law, which was designed to expand coverage for 30 million Americans, in part by adding 17 million people to Medicaid. But the impact of the Supreme Court’s ruling last week making the expansion voluntary is likely to be compounded by another provision in the law that the justices left intact: In 2014, states no longer are barred from making it harder for adults to qualify for Medicaid.
Experts worry that those two developments taken together could spur some states to reduce the number of people covered.
States could throw some low-income adults “into a black hole with nowhere to turn for coverage,” said Deborah Bachrach, who was New York’s Medicaid director until 2010 and now is special counsel at Manatt, Phelps & Phillips, a New York law firm. …
State officials haven’t talked about cutting Medicaid eligibility since the decision. But in the last several years, many have sought to reduce the cost of the program by cutting providers’ rates and contracting with private managed-care companies, among other strategies.
Florida is among the states that have been making deep cuts to the Medicaid program and has been in the process of privatizing most of it.
In short, the poorest of Floridians will be most affected — or rather, remain untouched — by reforms aimed at providing insurance to more people.
The Associated Press reported:
The ruling does point a way forward for millions who can’t get affordable coverage because they’ve been sick, they’re self-employed or they are otherwise shut out of the insurance plans that most Americans get in the workplace. But the path is clouded for millions more: the people on the bottom rungs of the economic ladder who are supposed to be reached by a major expansion of Medicaid.
Thanks to last week’s ruling on President Barack Obama’s overhaul, states can opt out of the expansion without fear that Washington will shut down all their federal Medicaid financing. And if some states do opt out, a lot of their residents are going to have to find another way to get coverage, or continue to go without.
Scott has said that he is resisting implementation of the law in the state because it would come at a crippling financial cost. However, most of Scott’s justifications for not following the law have been factually inaccurate so far. For Scott, this is also about ideology. He has spent millions of his own money to fight ACA and he is not backing down, yet.
The Washington Post’s Greg Sargent explained that there may even be some savings for states here and not just a cheap way for them to offer health insurance to more residents:
But what if opting in to the Medicaid expansion could actually save states money over the long term?
It’s very possible. The grounds for believing this can be found in an Urban Institute study that was conducted in 2011 but is newly relevant in light of the GOP governors’ threats.
The argument that opting in could devastate state budgets is grounded in the idea that while the federal government will cover the full cost for the first three years, by 2020 that number drops to 90 percent — and there’s no guarantee that the feds will continue footing the bill.
But that elides several important ways the Medicaid expansion couldsave money for states in other areas, the Urban Institute study concluded. First, the expansion could mean significant numbers of mental health patients now covered will soon be covered almost entirely by federal Medicaid funds. Second, the expansion could move many patients out of categories where states are currently paying a large matching share of Medicaid costs — such as pregnant women or people receiving long term home care — into Medicaid coverage that’s almost entirely paid for by the feds.
And third, the Affordable Care Act overall — partly because of the Medicaid expansion, and partly because of subsidies and exchanges — will cut down the number of uninsured in ways that could significantly reduce “uncompensated care” — i.e., care that patients don’t pay for, such as emergency services — thus reducing the amount of money states pay to hospitals to reimburse such care.
This is all beside the fact that having access to Medicaid is healthier for a person than not having any insurance at all. As Alex Blumberg at Planet Money reported, there is even research to prove it.