Monday, February 10, 2014

Slowly Awakening to the Need for the Medicaid Expansion?

Now it starts. What's surprising is to see that an article discussing the "coverage gap" in Obamacare -- people who make too little money to qualify for subsidies but live in the states, mostly southern, that didn't approve the Medicaid expansion and thus can't use Medicaid as envisioned in the ACA -- is in the Wall St. Journal, whose editorial page is dedicated to knocking the law down.

But at least it begins. We need Medicaid expansion in all 50 states, and we need it now. There are studies emerging that people will die because the several Republican governors and/or state legislatures refuse to play ball with the new law. But first, from the WSJ article:
Some GOP-led states are revisiting their decision as complaints pile up over the coverage gap—and its consequences for businesses—in such states as Utah and Florida. The state senate in New Hampshire last week reached a tentative deal to expand Medicaid. In Virginia, newly elected Democratic Gov. Terry McAuliffe hopes to get legislators to reverse his Republican predecessor's stance against expansion.
Lawmakers are also getting a push to boost Medicaid rolls from hospitals that expected a vast new pool of paying customers under the health-care law. Instead, the failure to expand Medicaid coverage by some states not only adds fewer insured patients, it also eliminates the payments hospitals had long received to cover the cost of uninsured people they treat free.
[...] For now, nearly five million people ages 18 to 64 get no financial help to buy coverage because of the gap, according to estimates by the Kaiser Family Foundation. Many of those people are clustered in the South, living in states where income limits for Medicaid coverage have historically been among the lowest in the U.S. [Boldface mine.]
There it is. The poorest region in the U.S. is not being helped by Obamacare because of Republican intransigence, pure and simple.

Now for the bad news about the health effects of turning down the Medicaid expansion:
Naturally, conservative writers in financial mags like Forbes are the first out of the woodwork to knock down the studies. Read this to see how to deny that people without Medicaid or any insurance at all don't have a greater chance of dying. Their argument is basically "New York and Pennsylvania must be statistical artifacts because death rates from lack of insurance are lower in other states," which basically boils down to "if we eliminate some of the data in the study because we don't like it, then we get the results we want." Nifty, Forbes.

The other argument, implicit from the first line of the article:
"Single-payer proponents Steffie Woolhandler and David Himmelstein (both physicians) are at it again. Their latest study purports to demonstrate that failure to expand Medicaid in the 25 states that have failed to do so will result in as many as 17,104 avoidable deaths each year among low-income Americans who remain uninsured.
In other words, those pesky liberals from Harvard are at it again.

I don't buy their argument, and I do buy the data in the study. If you don't have health insurance, especially the comprehensive coverage that includes preventive care, you risk dying. True, Medicaid coverage may be crappy, especially in southern states, so let's not let the poor have it.

A win for the GOP! Republican-controlled states have crappy or no Medicaid for the poor, but people won't get sick. Liberal studies from Harvard?!? Who reads that stuff?

Seriously, the WSJ article shows that the winning argument -- that Medicaid expansion will broaden as intransigent states are pressured to face reality and help their residents or lose businesses as they move away or expand in other states -- will prevail. It's already happening in states like New Hampshire, and perhaps Utah and Virginia.

It'll be an interesting process to watch.

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