Jaws dropped two years ago this week when the U.S. Supreme Court handed down its ruling on the constitutionality of the Affordable Care Act. What flabbergasted those of us who follow health care reform was not that the highest court in the land green-lighted President Barack Obama's landmark legislation, but that it derailed the one aspect of Obamacare that appeared to be a no-brainer: the mandated expansion of Medicaid.
By the Kaiser Family Foundation's estimate, more than 7.5 million uninsured adults would be eligible for coverage under the federal-state safety net today but for their misfortune to live in one of the 24 states that have so far opted not to expand Medicaid. Among this population, 4.8 million are too poor to be eligible for subsidized health insurance through the Obamacare exchanges, leaving them with no health insurance options at all. Pew Research estimates that 250,000 of the uncovered are veterans.
Did I mention that the federal government has offered to not only pick up the tab in the initial years but throw in a very attractive ongoing match payment for states that expand Medicaid?
Expansion states vs. non-expansion states
This largely overlooked and ongoing health care scandal of our own devising becomes even more troubling when you consider its impact on the urban poor. City leaders, who tend to skew Democratic and would welcome Medicaid expansion, find their hands tied in red states led by Republican-leaning state legislators more concerned with the political blow-back than with the practical benefits of the Obamacare Medicaid expansion.
The Urban Institute and the Robert Wood Johnson Foundation recently crunched the numbers on the impact of expanded Medicaid on 14 major U.S. cities -- half in expansion states and half in non-expansion states.
They found that, in the seven cities located in states that expanded Medicaid, the ACA could decrease the number of uninsured by 57 percent, on average, by 2016. The seven cities in states that didn't expand Medicaid would have seen their uninsured population decline by an estimated 52 percent, on average, with expansion. But without it, the ACA is expected to decrease their uninsured rolls only by an average of 30 percent by 2016.
Worse than the VA health care scandal?
What's more, states with some of the largest populations of uninsured adults stand to lose the most by not expanding Medicaid. These include:
- Texas (where an estimated 1.7 million would be covered)
- Florida (1.2 million)
- Georgia (599,000)
- North Carolina (511,000)
- Pennsylvania (454,000)
- Louisiana (363,000)
Vox.com blogger Ezra Klein puts the quiet Medicaid scandal in context with the recent headline-grabbing Veterans Administration wait list uproar this way: "As appalling as the wait times are for VA care, the people living in states that refused the Medicaid expansion aren't just waiting too long for care. They're not getting it at all."
In fact, Medicaid itself can be frustrating. Here's a look at the Medicaid expansion gap.
Follow me on Twitter: @omnisaurus.
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