An occasional line among opponents of states using federal Medicaid dollars to close the health coverage gap is that some states have been too successful in enrolling people in this new health coverage option – the uninsured rate in expansion states is apparently falling too quickly to suit some people. I wrote about the puzzling inconsistencies in this argument a few months ago, highlighting that before these commentators were suddenly worried about too many people enrolling in new health care coverage options, some of these same commentators were initially calling the law a failure because they felt too few people were enrolling in new health coverage under the Affordable Care Act.
While some would like to continue to have their rhetorical cake and eat it too, a few points to keep in mind as we hear about the shocking fact that hundreds of thousands of our fellow citizens are finally getting health coverage:
1. The latest US Census data from last month shows that the nation’s uninsured rate has dropped dramatically to at or near historic lows. Unfortunately, these gains are not evenly distributed. The same US Census report shows that states expanding Medicaid have seen dramatically higher reductions in their uninsured rates compared to states that continue to reject the federal money available to extend coverage to those below 138% of the poverty level (see above chart). Simply put, expanding Medicaid in a state means many more people get health coverage.
2. The fact of more people with health coverage is a clear, unalloyed good both for those individuals who get covered and our society as a whole. The majority of people who are helped by closing the coverage gap in states by using Medicaid funding are working in industries such as construction, retail and restaurants, hospitality or home health. I’m amazed that some political leaders even try and make the case that covering people is “morally reprehensible.” Funding and structure are the usual areas of debate, but calling the provision of basic health coverage that most of us take for granted to people in a coverage gap immoral is just “flat-out wrong”.
3. Medicaid expansion is creating significant budget savings in states that choose to accept the federal funding. A recent survey of state reports from experts at the Center on Budget and Policy Priorities details savings of $20.8 million in Arkansas, $25.8 million in Kentucky, $180 million in Michigan, $148 million in New Jersey, $60 million in New Mexico, $105.5 million in Washington state and $3.8 million in West Virginia.
4. The cost of doing nothing is great. Just this week, another rural hospital announced in North Carolina, a non-expansion state, that it was closing, a result at least one expert said needed to consider as part of the state’s refusal to accept federal Medicaid money. Rural hospitals see large numbers of uninsured patients and closing the coverage gap can help these hospitals keep their doors open and serving their communities.
