Medicaid Expansion: The American Romance

You don’t have to go to the theater to see a good drama. Microwave some popcorn, plant yourself on the couch, and tune into your favorite news station to see this classic American romance tale unfold.

It’s the love story that’s been retold countless times, but never gets old:

Boy loves girl. Girl shows no interest. Boy tries harder.

The story plays itself out, and viewers become enthralled even deeper: Boy strengthens his determination. Girl runs quickly in the opposite direction.

Inherently, the viewer roots for the underdog. How far will he go to win her heart? What obstacles will she throw his way? Will love conquer all?

In this particular romance tale, the male character is Obamacare. It makes an attractive appeal to provide healthcare for the sick and poor. Playing the role of the hard-to-get girl are the right-wing conservatives who have sworn an end to health care reform. And so the tale begins.

The Affordable Care Act (ACA) is designed to reduce overall health care costs by making services available to the 32 million who currently can’t get insurance. They often use a hospital emergency room for their primary care, increasing costs for everyone. The ACA is set to begin full-scale implementation in 2014.

Under the Act, states are encouraged to expand Medicaid to adults with income below 138 percent of the federal poverty level. This represents the single largest eligibility expansion since the establishment of the Medicaid program in 1965.

People with existing health insurance will keep it. Businesses prefer to offer a tax-free benefit like health insurance to attract good workers. That won’t change under Obamacare.

But, alas, the right-wing conservatives say no.

Determined to overcome rejection, Obamacare tries harder: Parents can put children, up to age 26, on their health insurance plans. This will bring more profit for health insurance companies, since they will receive more premiums without higher costs for these healthier individuals. According to the Department of Health and Human Services, as of 2012, more than 3 million previously uninsured young people were added.

Also under the Act, insurers cannot deny coverage for pre-existing conditions and can no longer drop anyone from coverage once they get sick. If someone is denied coverage, he or she can file an appeal.

Still, Obamacare gets no love. The plot thickens when right-wing conservatives play hard-to-get, and argues health-care reform is unconstitutional. Every great romance story needs a good conflict.

Obamacare rises above the challenge victoriously. The Supreme Court affirms that health-care reform is constitutional. To assist Obamacare with winning over the hearts and minds of the right-wing, the Justices offer him a tip. They remind Obamacare that he can’t force the right-wing into a loving relationship; but advised that if he asks nicely, then maybe she will come around.

With a steadfast will and drive, Obamacare continues its course. He sweetens his appeal and politely asks for acceptance. With arms outstretched, Obamacare offers to completely cover the costs of the relationship. For people who can’t afford health insurance, the Federal government will pay the states to add them to Medicaid from now until the year 2020. Accordingly, under Obamacare, states no longer have to finance health insurance for people above 138 percent of the federal poverty level. Obamacare makes residents at higher than 138 percent of the FPL eligible for subsidized health insurance through state insurance exchanges at no cost to states. For example, Idaho would no longer have to fund health insurance for its 63 percent of uninsured residents who are above 138 percent of the FPL, reducing its $47 million annual uncompensated care cost to $17.3 million.

Sounds great, doesn’t it; but he’s just getting warmed up: Under Obamacare, states pay billions less to cover people below 133 percent of the federal poverty level. States pay billions in health insurance programs for residents living at less than 138 percent of the federal poverty level. After five years of Obamacare, the federal government will cover 90 percent of insurance costs for state residents making less than 138 percent of the federal poverty level. For the first three years of the expanded Medicaid program, the federal government will cover 100 percent of Medicaid costs. States could potentially save $4.2 billion (100 percent of their uncompensated care costs) annually for the first three years, and $3.0 billion annually starting in 2019. For example, Michigan pays $212 million annually in uncompensated care costs. After five years of Obamacare, Michigan would have to pay only $68 million annually in the expanded Medicaid program.

Finally and here’s the true clincher, Obamacare is offering all of this with no expectation of a commitment. Cindy Mann, director of the Center for Medicaid and Children’s Health Insurance Program Services at CMS, said at a recent National Conference of State Legislatures meeting that Obamacare will allow states to expand Medicaid to 138 percent on their own timetable, not tied to January 2014, and then can scale back after the fact if they so choose. Obamacare is asking for just a chance to try things out. No marriage. A simple date.

America loves a good romance and this tale is a great one. Viewers can only hope the right-wing conservatives will eventually wise up and accept Obamacare in all of his charm and beauty. The lives of many are depending on it; after all, every great tale needs a happily ever after ending.


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