Fwd: qotd: State Medicaid opt-out will cost over 7, 000 lives, maybe 17, 000

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-------- Original Message --------
Subject: qotd: State Medicaid opt-out will cost over 7, 000 lives,
maybe 17, 000
Date: Thu, 30 Jan 2014 08:58:27 -0800
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



Health Affairs Blog
January 30, 2014
Opting Out Of Medicaid Expansion: The Health And Financial Impacts
By Sam Dickman, David Himmelstein, Danny McCormick, and Steffie Woolhandler

The Affordable Care Act (ACA) was designed to increase access to health
insurance by: 1) requiring states to expand Medicaid eligibility to
people with incomes less than 138 percent of the Federal Poverty Level
(FPL) ($19,530 for a family of three in 2013), with the cost of expanded
eligibility mostly paid by the federal government; 2) establishing
online insurance "exchanges" with regulated benefit structures where
people can comparison shop for insurance plans; and 3) requiring most
uninsured people with incomes above 138 percent FPL to purchase
insurance or face financial penalties, while providing premium subsidies
for those up to 400 percent of FPL.

Recent studies suggest that Medicaid expansion will result in health and
financial gains. Older studies also found salutary health effects of
expanded or improved insurance coverage, particularly for lower income
adults.

The Supreme Court ruled in June 2012 that states may opt out of Medicaid
expansion, and as of November 2013, 25 states have done so.

The Consequences of Opting Out

The Supreme Court's decision to allow states to opt out of Medicaid
expansion will have adverse health and financial consequences. Based on
recent data from the Oregon Health Insurance Experiment, we predict that
many low-income women will forego recommended breast and cervical cancer
screening; diabetics will forego medications, and all low-income adults
will face a greater likelihood of depression, catastrophic medical
expenses, and death.

The ACA's tax subsidy for insurance purchase on the Exchanges is only
available to persons with incomes above 100 percent of FPL. People
below this threshold in opt-out states (the so-called low-income
"coverage gap") will see no benefit as the law goes into effect. They
may even see harm because the ACA cuts disproportionate share (DSH)
funding to safety net hospitals, reducing the resources available to
care for the remaining uninsured.

Examining the numbers

Nationwide, 47,950,687 people were uninsured in 2012; the number of
uninsured is expected to decrease by about 16 million after
implementation of the ACA, leaving 32,202,633 uninsured. Nearly 8
million of these remaining uninsured would have gotten coverage had
their state opted in. States opting in to Medicaid expansion will
experience a decrease of 48.9 percent in their uninsured population
versus an 18.1 percent decrease in opt-out states.

We estimate the number of deaths attributable to the lack of Medicaid
expansion in opt-out states at between 7,115 and 17,104. Medicaid
expansion in opt-out states would have resulted in 712,037 fewer persons
screening positive for depression and 240,700 fewer individuals
suffering catastrophic medical expenditures. Medicaid expansion in these
states would have resulted in 422,553 more diabetics receiving
medication for their illness, 195,492 more mammograms among women age
50-64 years and 443,677 more pap smears among women age 21-64. Expansion
would have resulted in an additional 658,888 women in need of mammograms
gaining insurance, as well as 3.1 million women who should receive
regular pap smears.

http://healthaffairs.org/blog/2014/01/30/opting-out-of-medicaid-expansion-the-health-and-financial-impacts/


Comment: Apparently for no other purpose than to make a political
statement, politicians in about half of our states are willing to expose
about 8 million poor people to further financial hardship and greater
impairment in health care access. More than 7,000 of those people will
die as a result. That's not simply politics; that's a crime!

In a PNHP press release, Dr. David Himmelstein, co-author of the study
and co-founder of PNHP said it well: "Medicaid is far from perfect. In
many parts of the country Medicaid pays so little that patients have
trouble finding a doctor who will accept it. A single-payer program like
Canada's that covers all Americans is a far better solution for both the
poor and the middle class. But until we get to single payer, Medicaid is
the only safety net for many low-income Americans."

PNHP press release:
http://www.pnhp.org/news/2014/january/more-than-7100-deaths-likely-from-states-rejection-of-medicaid-expansion-%C2%A0health-a