Brad Wright did an outstanding job with the Health Wonk Review this week, hosted at his always excellent blog, Wright on Health. There are plenty of posts about the latest in ACA implementation, including several differing viewpoints on the recent news about policy cancellations.
I particularly liked Joe Paduda’s article about Medicaid expansion – it’s an excellent summary of where we are now, and where we’re likely to be in the future. Joe makes a great point about the current expansion map looking very similar to the original Medicaid creation map from nearly 50 years ago… eventually the other states got on board, but they weren’t eager to do it right off the bat. I wrote about Medicaid expansion recently on HealthInsurance.org, explaining the significant financial downsides for states that refuse to expand their Medicaid programs.
One of the bottom-line points here is that if your state is not expanding Medicaid, you’re going to be paying more for your health insurance than you would if your state were participating in Medicaid expansion. Uncompensated care will remain more of an issue in states that aren’t expanding Medicaid, since many of the people who would otherwise qualify for Medicaid will remain uninsured (remember that subsidies in the exchanges don’t apply to people with incomes below 100% of poverty level… they were supposed to get Medicaid instead). And the federal government is going to be cutting the additional payments that they make to hospitals that see a significant number of uninsured patients. All of that translates to more costs getting shifted to private health insurance, and higher premiums for everyone.
I agree with Joe – I think that the other states will eventually get on board with Medicaid expansion. But I also agree with Brad’s take on this: those states might wait a while and see where the political waters take them, so that they can not lose face on the issue.