The one downside public policy wise to the Supreme Court’s upholding of the Affordable Care Act was the ruling that the federal government can’t penalize the state’s for not accepting the Medicaid expansion. Not weighing in on the constitutional issue there, just talking about the real world, practical effects. That said, we’re now confronted with a situation where Republicans in state governments, whose only governing philosophy seems to be to spite the President and who’s only health care plan seems to be “die faster”, are now insisting that they will block the Medicaid expansion apparently just because. Arkansas Republicans are no exception and if they take over the state legislature, or even just a single chamber of it, expect just that to happen. So what’s that mean for Arkansas? Will, mercifully, the Washington Post spells it out in a wonderful little chart and they were even nice enough to use Arkansas as their example:
State rules on who qualifies for Medicaid vary widely. The Affordable Care Act would bring all states up to the same standard: Everyone with incomes at 133 percent of the federal poverty level would receive coverage. But the Supreme Court ruled that states can’t be penalized if they don’t go along with the expansion. In states that opt out, poor people who would otherwise have been newly eligible for Medicaid would not receive it. Still, because of a quirk in the law, the most well-off of these people — those with incomes between the federal poverty level and 133 percent of that level — would become eligible for an alternative: federal subsidies to buy private insurance plans in state-based marketplaces, or exchanges, created by the law.
So what we’ll have if we don’t accept the expansion is a huge chunk of people who should be eligible for Medicaid left out in the cold. It’ll be a continuation of a problem that has persisted for years-a class of Americans who, while still poor, are too rich for Medicaid and too poor for private insurance. It’s a situation that the Affordable Care Act was meant to stop but that Republicans are determined to see continue.
But there’s more. Not only would we be rejecting a ton of money (our money that we paid in that we will be sending to other states with no benefit to us if Republicans have their way) to solve a major problem and help a lot of hard working Arkansans get a basic human need, but we’ll also be rejecting something that could save the tax payer a lot of money.
But, via Greg Sargent, here’s a 2011 study [pdf] from the Urban Institute that shows just how much states could save in other budget areas by taking on this expansion. The bottom line: “state would spend $92 to $129 billion less under the ACA than without it [...] between 2014 and 2019.”
Those savings come from a variety of sources. Notably, they project that spending on uncompensated care—the care the uninsured get at emergency rooms that has to be paid for by states and localities—will be halved. Patients with mental illnesses will be moved from programs covered by states’ general funds to the Medicaid, as well as populations like pregnant women and people in long-term care. Having those groups covered by the federal funds will achieve big savings in state Medicaid obligations for all states, including those where the governors are balking.
The bottom line is, Arkansas could, by accepting the expansion, save the taxpayer up to $362 million. That’s the high saving scenario, but it greatly outweighs the cost presented in the low saving scenario, never mind what the expense of leaving all those people without some kind of insurance is on Arkansas’s health care system.
But all that should be secondary in the concerns of our public servants. You know what should be first? Remember all those Arkansans that lined up in Little Rock for the free clinic in 2009 that highlighted the need for health care reform? Those people should be the first priority.
I’m talking about Vicky Hansen, the lady who after being diagnosed with cancer couldn’t get health insurance, couldn’t afford to see a doctor, and had to live every day with both her cancer and the pain of an abscessed tooth.
I’m talking about Steve, the self employed businessman with sky high blood pressure who couldn’t afford insurance despite working hard and doing what we expect everyone should.
I’m talking about Keith, the man who needed either private insurance or Medicaid to get a prosthetic leg.
This sort of thing should not be allowed to happen in the greatest country on the face of the Earth. That was the whole point of the Affordable Care Act. These are the people whose lives Republicans are playing with here. If they get their way, these are the people that are going to be hurt.