Views on the News: Medicaid Expansion
The current healthcare system could see a major shakeup after Nov. 6. Several Democrats running for governor in states that rejected the Affordable Care Act’s Medicaid expansion, like Stacey Abrams (D-Ga.) and Andrew Gillum (D-Fla.), have made healthcare access a major issue in their campaigns. Additionally, five states have Medicaid expansion as a direct ballot issue. How you feel about expanding Medicaid, and how could proposed expansions affect the upcoming elections?
Prof. Emeritus F. Trenery Dolbear (ECON)
Clearly many Democrats see both protecting coverage of preexisting conditions and expanding coverage, especially Medicaid, as their best election issues. Idaho, Montana, Nebraska, and Utah have ballot questions on Medicaid expansion. A half-dozen other states that rejected Medicaid expansion have election contests that could install Governors and others more sympathetic to Medicaid. To most people healthcare is very important; many have become more receptive to Obamacare as they better understand what’s at stake, especially the prospect of losing coverage for preexisting condition. But our current system — Obamacare, Medicare, Medicaid and private, largely employer-based, insurance — leaves a lot to be desired. However, dialing back coverage is not a promising route to improvements. Expansion will create budget problems creating serious pressures for a redesign of our health system. It won’t be easy, given the political divisions in Washington.
Prof. Emeritus Trenery Dolbear Jr. specializes in macroeconomics, the public sector, and choice under uncertainty.
Prof. Sarah Curi (HSSP)
Medical expansion is a matter of social justice. The primary factor in Americans accessing health care is having health insurance. Those without health insurance have worse health status and worse access to care than do other Americans. Medicaid expansion seeks to redress these disparities through expanded health insurance coverage. Medicaid is a federal/state health insurance program: eligibility is based on income, household size, disability, family status, and other factors. Eligibility rules differ between states. In thirty-three states plus the District of Columbia, Medicaid expansion has improved access to care, utilization of services and the affordability of care. If the five currently considering adopting Medicaid expansion as a direct ballot issue, then such expansion will save the lives and improve the health status of some of the most vulnerable Americans, among the low-income broadly and within specific vulnerable populations in those states.
Prof. Sarah Curi is a lecturer in Health: Science, Society and Policy and Legal Studies.
Prof. Alice Noble (HELLER)
The 2010 Affordable Care Act expanded Medicaid to provide universal health coverage for all below 138% of the poverty line, but the historic SCOTUS opinion, NFIB v. Sebelius, demoted the mandate to an “option” for the states. Staunchly resisted in red states, Medicaid expansion was ultimately adopted in 34 states, where its merits have become apparent. Expansion states are enjoying generous federal subsidies to insure the expansion population, and a better-funded health care sector is improving those states’ economies. Midterm elections may see another wave of states joining the expansion if Democrats make gains in governorships and statehouses. In Republican strongholds, Idaho, Nebraska, Utah, and Montana, a surprising grass roots effort has added Medicaid expansion referenda to the ballot. Thus, the midterm elections will indicate whether Medicaid expansion is finally reaching its intended goal as an important, new “normal” in our national quest for a just health care system.
Prof. Alice Noble (HELLER) is a Senior Lecturer in Health: Science, Society and Policy and Legal Studies, specializing in health care reform and medical ethics law.
Carrie Sheng ’21
Medicaid expansion is a key issue in political races, and it has dominated many midterm campaigns this year. Health care is an individual necessity as is plays a big part of almost everyone’s life. The left is usually benefited politically from expanding Medicaid eligibility and benefits. It will still be a major issue for Democratic candidates during the Massachusetts gubernatorial run on Nov. 6.The original intention to expand Medicaid under the Affordable Care Act is to serve as a more affordable health insurance plan for the income. In fact, Medicaid lowers payments to providers and reduces patients’ access to care as their problems may be left untreated. Meanwhile, the federal rules prohibit Medicaid-eligible patients from getting treated at charity clinics yet the fixed demand will leave them waiting in a longer line.
Carrie Sheng ’20 is majoring in Philosophy, International and Global Studies and Studio Art and minoring in Legal Studies and Art History.