By Teresa Welsh |
By expanding Medicaid, the Affordable Care Act sets out to cover some 17 million uninsured Americans. Many in this group are adults who currently don't qualify for the program because they don't have children. In most states single adults and childless couples are not considered among "the worthy poor," no matter how little they earn. The Affordable Care Act would change that, extending the safety net to everyone with incomes at or below 133 percent of the federal poverty level; $14,404 for an individual, or $29,326 for a family of four. Today, eligibility varies from state to state: Texas only covers working adults up to 26 percent of the poverty line.
But, some ask: "Can the states really afford such an enormous expansion of this program?"
The better question is: "How can they afford not to expand Medicaid?" Beginning in 2014, Washington will cover nearly 100 percent of the cost for three years, 90 percent after 2020. Washington now picks up just 57 percent of the tab for existing Medicaid patients.
Nevertheless, a handful of conservative governors who abhor "Obamacare" are adamant: They won't take the money.
Unfortunately, their political passion could cost their states dearly. If these governors dig in their heels, hospitals in their states will continue to struggle to care for millions of patients who cannot pay their bills. As the cost of uncompensated care mounts, these hospitals will shift that cost to insured patients, and premiums will rise.
Alternatively, if these states accept Washington's offer, those Medicaid dollars would create jobs. As more low-income patients have access to care, hospitals, community health centers, labs, and nursing homes will need to hire new workers.
States desperately need those jobs. And their poorest citizens desperately need healthcare.
Some claim that American citizens always receive the care they need. But this just isn't true. If a patient lands in an emergency room, the hospital has a legal obligation to stabilize her, but it isn't required to give her the surgery that might save her life.
Nevertheless, just stabilizing a patient can be expensive. It may mean admitting her to the hospital, and caring for her until she expires—or is well enough to walk away, still not having received the operation she needs.
It's a lose-lose situation for everyone: the hospital, the Medicaid patient, the community, and other patients who wind up paying for her less-than-optimal care.
About Maggie Mahar Author of 'Money-Driven Medicine: The Real Reason Health Care Costs So Much'
Rick Scott Republican Governor of Florida
Michael D. Tanner Author of 'Bad Medicine: A Guide to the Real Costs and Consequences of the New Health Care Law'
Grace-Marie Turner President of the Galen Institute
Scott Randolph Democratic Florida State Representative
Ethan Rome Executive Director of Health Care for America Now
Rick Mayes Associate Professor of Public Policy at the University of Richmond