No sooner had the U.S. Supreme Court ruled in support of the constitutionality of the federal health care reform law, than a new attack was launched on health coverage for the poor.
One provision of the Affordable Care Act dramatically expanded the Medicaid program – which provides health insurance for the poor. The ACA requires that states have to expand coverage to those who make just above poverty level. If a state refused the expansion, the federal government would withdraw its funding of that state’s program.
Under federal law, both the federal and state governments jointly fund Medicaid. The wealthiest states receive a match of federal dollars amounting to 50 percent of the total cost of their Medicaid programs. Poorer states receive a larger federal share. Nationwide, the federal government provides nearly 60 percent of all Medicaid funding.
In its decision on the Affordable Care Act, the Supreme Court ruled that the federal government could not “threaten” to pull its Medicaid support if a state refused to expand eligibility. The law also required states to keep their existing eligibility standards for current Medicaid beneficiaries in place or risk losing federal funding at least until 2014.
Once the Court made its determination, states not only pledged to ignore the future Medicaid expansion mandated by the federal law, but also slash current enrollment in the program.
For example, lawyers in the Maine attorney general's office began preparing a legal argument to allow health officials to strike more than 20,000 Medicaid recipients from the state's rolls—including 19- and 20-year-olds—beginning in October.
According to media reports, other states, including Wisconsin and Alabama, are expected to follow Maine's lead. While it is clear that the Court ruled that the federal government could not “force” states to expand coverage, it’s not clear that their ruling also gives states the power to reduce current Medicaid enrollments. If states act, there could be legal battles between states and the federal government that could drag the health law back to the courts.
States are under enormous pressure to keep their budgets balanced. They face a tepid national recovery which has not restored tax revenues to pre-recession levels. However, the impact of the Great Recession has left many Americans without jobs – and the health insurance that often goes with it. So, just as tax revenues are essentially stagnant, the need for government help is growing – that’s the “rock and the hard place” where policymakers are feeling the pinch.
In addition to the real difficulty of providing health to people who need it, some are using the fiscal crisis to drive their own ideological agendas. In this case, that ideology opposes government health insurance for the poor.
The Supreme Court decision has fueled that effort. Now, some states are looking to use the Court’s decision to drastically cut back help to poor people.
But what will be the consequences? People who are struggling often get sick. What happens to them? Under current laws, patients in need cannot be denied medical care and so hospitals either cover the costs or access government programs that help cover such charity cases.
Since the uninsured don’t have coverage, they go to the emergency room when they have a potentially serious illness. If they had had insurance coverage through Medicaid, they would have been likely to access routine checkups and needed physicians. Early access to medical treatment can stop a more routine illness from becoming a medical emergency – all too often a very expensive form of care.
No one should lose access to health insurance coverage because of someone’s political ideology or passion to score political “points.” If people need Medicaid coverage, they should get it.
Blair Horner is the Vice President for Advocacy for the American Cancer Society, Eastern Division. His commentary does not necessarily reflect the views of the American Cancer Society.
The views expressed by commentators are solely those of the authors, and do not reflect the views of this station or its management.