Leaving Money on the Table

Now that the furor immediately surrounding the Supreme Court’s decision upholding the Affordable Care Act has died down, the battle for healthcare coverage has moved to the individual states. According to this infographic from MSNBC, only four states have said outright they will refuse to take up the Medicaid expansion, but nine states have stated that they will expand, and several others are leaning yes. In states like Nebraska that are yet undecided, but leaning “No,” thoughtful consideration needs to be given to what we are giving up in terms of federal funding and a real solution to bringing down the costs we all share in our current system.

However, even in states like Texas and Florida, where the governors have made strong statements against the Medicaid expansion, providers and consumer advocates are putting pressure on state lawmakers to carry on. Texas has one of the highest uninsured rates in the country, mostly made up of the working poor–those whose employers don’t offer insurance and can’t afford insurance in the private market, or who can’t afford the insurance their employer offers.

Without health insurance, these hardworking individuals and families will continue to access health care through the emergency room, and will struggle to pay for it.  Some of those costs are considered “charity care,” and hospitals accept the loss. But the rest of those costs are “uncompensated care,”  which makes healthcare more expensive for everyone.

Advocates in Florida have recognized that Medicaid is the only realistic option for the working poor, and they make the point that those with health insurance are healthier than those without. Fuss over Medicaid is nothing new.  When the initiative was first introduced in 1965, few states chose to participate. Now, every state has a Medicaid program.

Everyone agrees that the goal here must be controlling costs, but that’s exactly what the Medicaid expansion proposes to do. Consider:

  • Those without insurance put off going to the doctor until they become very sick, which requires more expensive care.
  • Chronic conditions that can be managed–such as diabetes and heart disease–can cause serious, and expensive, complications without proper care.  But without insurance, condition management is too costly, which then results in more expensive care and poorer outcomes.
  • Preventive measures, which Medicaid will cover, are shown to cut back drastically on costs and improve outcomes.
  • Overall, people with insurance are healthier than people who do not have insurance, and a recent study suggests that expanding Medicaid may result in fewer deaths.
  • Everyone ends up paying more as a result of uncompensated care for those without any form of insurance. Families USA estimated that uncompensated care added an extra $1,017 to annual family health insurance premiums and an additional $368 to individual premiums in 2008. The rising cost of premiums means that fewer people are able to afford health insurance, resulting in more uninsured, more uncompensated care, and even higher costs.
  • The Medicaid expansion will return $2.3 to $2.7 billion to Nebraska’s economy through these federal funds from 2014-2019. Otherwise these funds will only go to states that DO decide to expand Medicaid.
  • States that have done the research have estimated millions in savings to their state budgets (like Arkansas), as well as the creation of jobs (like Washington).


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