Wednesday, October 12, 2016

Student believes the expansion of Medicaid makes sense for all states

A student's musing on the Affordable Care Act for a reaction paper.

For reflection, I’ve chosen to give more thought about the Affordable Care Act and the Supreme Court’s ruling that Medicaid expansion be considered optional. I’ve read a few articles that both support and oppose this ruling, but I always come back to the same opinion. It should be required. When Lyndon B. Johnson signed Medicare and Medicaid into law in 1965, he stated it was to “improve a wide range of health and medical services for Americans of all ages” (2012, He didn’t say it was only for the elderly, or for single pregnant women, or just for children. He said Americans of all ages. Yet somehow, there has been a huge disparity between the ages these programs serve.

Medicare provides free hospital coverage to people who are over age 65, permanently disabled, or dying of a terminal illness. Medicare Part A, the free coverage, only covers in-hospital services. So you have to be so sick that you have to be admitted to the hospital for Medicare to kick in. Medicare Part B is only available to the same populations for a monthly cost, averaging $100-120 per month (Lankford, 2015), but will cover some outpatient services with a deductible and co-shares on payments. Medicare Part D is for prescriptions and also carries a fee. Another interesting note many people don’t know is people who are disabled are not eligible to receive Medicare until they have been on Social Security Disability for two years. Two years is a long time for someone the government has found to be permanently disabled to wait for insurance.

Then there is Medicaid. If not expanded under the Affordable Care Act, most states have very stringent guidelines on who is eligible to receive Medicaid. In the state of Missouri, it’s for children, single pregnant women, and single parents with an income of 18% or less of the federal poverty level (, 2016). This means a single parent can only have an income of 18% of $11,880, or $2,138.40 (2016, In Florida, when I was found disabled by the Social Security Administration, my monthly payment was only $650 per month. I was single, disabled, and still ineligible for Medicare, so I sought help through the state Medicaid office. I was ineligible for the regular program, but they had Medicaid for the “medically needy” as a different program. I could get it if I paid them $400 per month out of my $650. People can’t live on $250 per month. This was long before the Affordable Care Act, and I was denied private insurance automatically because of my pre-existing condition, so I had no insurance and no way to receive treatment for a chronic, debilitating, and painful disease. 

I look at the states which immediately opted to expand their Medicaid coverage and think “Bravo! There’s a state that cares about the health of its residents!” Other states claim the costs to expand coverage are too high, despite the additional federal funding they would receive for expansion. But have they not considered the increase in productivity of their workers when they can actually visit a doctor when they are ill? Have they considered the increased revenue in sales tax from those workers, who would have less unpaid sick days, who now have higher earnings to spend in the economy? I believe finding the funds to keep people healthy should take a major priority in state budget plans.

Lankford, K. (2015). How Much Will Your Medicare Part B Premiums Cost in 2016? Kiplinger (2016). Federal Poverty Level. Retrieved on September 19, 2016 from, LLC. (2016). Missouri Medicaid. Retrieved on September 19, 2016 from

LBJ Presidential Library. (2012). The 1965 Medicare Amendment to the Social Security Act.

My understanding is that government officials in the states that have refused to expand Medicaid have an ideological opposition to the expansion of government responsibility for health care.  They do not think the government should become larger.  In the long-term, the ACA hopes to cut public health care costs, but these people who oppose the ACA think that this will fail.  Their moral reasoning is that if they allow Medicaid to expand in their states, they will be enabling the government to expand in a way that is unsustainable.  In the long-run, it is correct to point out that running large federal deficits every year, even when we aren't in a recession or recovery from a recession, will increase the portion of tax revenue that must go to pay off interest on the nation debt, and that will reduce money we have available for other discretionary spending.  So, if you disagree with the forecasts that the ACA saves the government money in the long run, or that its overall cost is relatively low, and the benefits it provides are relatively high, then you have a different perspective of reality, and it is possible to make a moral argument in opposition to the ACA's expansion of Medicaid.

Many of us have no ideological opposition to allowing the government to expand a bit more, and raising taxes by a few percentage points doesn't really frighten us.  Others are ideologically opposed to any expansion of government or any increase in taxes.  For them, this value is a priority, and the arguments based on benefits to society or justice for the poor or care for the ill do not persuade, because the value of "keep government small and remove the government from the free market" is considered more important.  This is difficult sometimes for me to understand, because it seems to me that this dedication to the principle of "small government and unconstrained free market" only makes sense if it provides better long-term outcomes: a more prosperous society with greater freedom and less poverty and injustice and misery, and I don't see the evidence for this being general and universal (in certain contexts, within certain limits, yes, of course free markets give us better outcomes than certain types of government intervention, but I don't see this always being true in every situation). 

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