Medicaid: Are You In or Out?

by Mike Walker

March 12, 2014

Cover Photo Credits

In October of 2013, the health care exchanges, touted in the infamous Affordable Care and Patient Protection Act (ACA), went live. The goal was to give some 32 million uninsured Americans easy access to the coverage promised in the law. As with any government funded project, the exchanges have met many obstacles. We all know that. However, in the midst of the difficulties experienced with the law and its medical exchanges lies a greater obstacle—the states’ right to ‘opt-in’ or ‘opt-out’ of the federal government’s billion dollar Medicaid expansion.

While—as of now—a handful of states of states are entertaining open debates over the issue, 19 states have decided to opt-out of the expansion all together. As the Health Affairs blog demonstrates, the consequences of the opt-out could be costly. Heath Affairs compiled data from a number of studies, such as the Oregon Health Institute, and has generated compelling projections for both opt-in and opt-out states. According to their projections, there will be an astounding contrast between the states with Medicaid expansion, and everyone else. To illustrate this contrast, consider two states with a similar number of uninsured citizens: Virginia, a state entrenched in the dispute; and Washington, a state that has decided to implement the federal Medicaid funding.

According to these studies, Virginia is currently home to 997,665 uninsured citizens, many of whom are a part of low-income households. If the state were to opt-out of Medicaid expansion, 808,996 citizens will still be without insurance. Leaving over 80% of the uninsured population without the health insurance would render the ACA practically useless. The projections become even more sobering when juxtaposed against the projections for the state of Washington. Washington’s current population of uninsured citizens, 932,584, is similar to the state of Virginia’s. However, because Washington opted into Medicaid expansion, nearly half of its uninsured population, 481,870, is projected to be covered once the early dust has settled.

While the numbers provide a lucid argument for opting-in to Medicaid expansion, the details tell a more complete story. So, what are the potential consequences of moving forward without Medicaid expansion? According toHealth Affairs, the lack of healthcare expanded to those in the lower economic classes will prove to be devastating in a number of key areas of health.  Low-income voting eligible citizens will be at greater risk of insurmountable medical expenses due to a rising amount of both out-patient care, as well as emergency room visits. Additionally, “low-income women will forego recommended breast and cervical cancer screening,” simply because they cannot afford it. Depression, diabetes, and other conditions will go untreated. This all, of course, will lead to a higher mortality rate among those below the poverty line.

If the data gather by Health Affairs bears any resemblance to reality, I think the message is clear. Aside from billions of potential federal funding, the ‘opt-out’ states will forego ensuring the health of thousands of their citizens.  The discrepancies between the ‘opt-in’ and ‘opt-out’ states are so large that there should not be an argument. Uninsured Americans have enough obstacles to jump through, but Medicaid access should not be one of them.

Mike Walker is a sophomore Public Policy major at the College of William & Mary. Mike was born and raised in Northeast Philadelphia.