The pros:
1. Since the federal government has promised to pay for "100 percent [of this cost] for the first three years, and then declining gradually to no less than 90 percent in future years," if this promise is kept, the states will have to pay for at most only 10% of the cost of expansion.
2. A 2012 study found that "State Medicaid expansions to cover low-income adults were significantly associated with reduced mortality as well as improved coverage, access to care, and self-reported health." Another more recent study found that "The ACA Medicaid expansion has the potential to improve a wide variety of coverage, access, financial, and health outcomes for uninsured parents in states that choose to expand coverage."
3. If you choose not to expand Medicaid, your state may end up like Texas, which is eschewing $100 billion of federal money over a decade by doing so, and not insuring over a million people. In addition, the state is spending $5.5 billion per year treating the uninsured, which is being covered by "taxes and insurance premiums paid by the state's businesses and residents, who are also footing the bill for expanding Medicaid in 29 states and the District of Columbia that agreed to accept federal funds to offer coverage to nearly all poor adults."
The cons:
1. The key word in the first statement is "if": some conservatives have argued that the next congress might change this provision by "decid[ing] to fund Syrian refugees and foreign worker visas rather than Medicaid" or, if the Fed raises interest rates, "raid[ing] Medicaid and get a few extra billion for interest payments."
2. Doctors don't get paid as much for seeing Medicaid patients as they do for seeing Medicare patients. Obamacare fixed this by requiring doctors to get paid the same amount for seeing either type of patient, but this fix was temporary, and beginning in 2015, according to the Urban Institute, primary care doctors' Medicaid payments declined by 43%. This led to many doctors not seeing as many Medicaid patients. As the Federalist argued in 2014, "Too often the current Medicaid program denies patients access to care, since about 40 percent of primary care doctors do not even accept Medicaid patients because the reimbursements are so low."
3. Another argument is that, in line with point 2 above, according to Alan Reynolds of the Cato Institute, "Medicare reimbursement rates are far too low to cover the costs of high-quality medical services, and Medicaid reimbursement is even worse."
4. Another big argument is that the costs of Medicaid borne by the states, although only 10% of the total, are still substantial, and that costs have been much higher than anticipated for the states that have expanded.
5. Medicaid is ineffective at improving health outcomes. This claim is generally based on the Oregon Medicaid experiment, the results of which were published in lots of different journals, including the New England Journal of Medicine in 2013. This study concluded that "...Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain."
5. Medicaid is ineffective at improving health outcomes. This claim is generally based on the Oregon Medicaid experiment, the results of which were published in lots of different journals, including the New England Journal of Medicine in 2013. This study concluded that "...Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain."
Now to debunk the "cons":
1. This is mere speculation: the only way states would have to pay >10% of the costs more than 3 years after the expansion would be if "Congress passed a law to change the ratio." Also, as the New York Times Editorial Board noted, despite GOP concerns that the federal government might back off from paying 90%, "there is no reason to believe that will happen, and if it does, it can be resolved when it arises."
2. Putting this claim to the test would require looking at states that have expanded Medicaid and seeing whether more or fewer people are being seen by doctors. As it happens, the Oregon Medicaid experiment (you know, the one cited as proof "Medicaid doesn’t actually improve health outcomes") debunked this claim: one of its authors said that "We can eliminate the story that Medicaid is so lousy you can’t get in to see a doctor" because in the study, "People who gained access to Medicaid did use more health care".
3. According to the Urban Institute, revenues of hospitals in states that expanded Medicaid would be expected to "increase [by] nearly $300 billion over the 2013-2022 period – a 23% increase in Medicaid reimbursement for hospitals." Besides that, as noted in the point just above this one, people on Medicaid "did use more health care" in the Oregon experiment, and the 2012 study cited in point 2 in the "Pros" section reached similar conclusions.
4. In reality, it costs more not to expand Medicaid than to expand it. The Kaiser Family Foundation found that states (and Washington DC) "that didn't broaden coverage saw their Medicaid costs rise 6.9 percent in the fiscal year that ended Sept. 30. The 29 states that took President Obama up on his offer to foot the bill for expanding Medicaid saw their costs rise only 3.4 percent." Similarly, a 2013 RAND study found that the 14 states that had, at the time, announced their intention not to expand Medicaid actually refused to do so, they would "collectively will spend $1 billion more on uncompensated care in 2016 than they would if Medicaid is expanded." In part this is because states like Texas that refuse to expand Medicaid still have to spent money ($5.5 billion per year for Texas alone) treating the uninsured--money that the state has to cover with taxes rather than taking billions it from the federal government.
5. See the 2012 study above--you know, the one that found that "State Medicaid expansions to cover low-income adults were significantly associated with reduced mortality as well as improved coverage, access to care, and self-reported health", linked here again for your convenience. Now, it's true that the Oregon study reached the opposite conclusion w/respect to outcomes. But this may not mean that Medicaid expansion doesn't work, because the same study found that such expansion was associated with increased "rates of diabetes detection and management, and it reduced observed rates of depression by 30 percent." There are also some limitations to this study, including that it "measured only three health indicators — blood-pressure, cholesterol and glycated hemoglobin levels (which measure diabetic blood sugar control) — and only over a two-year period." Another study estimated that "Medicaid expansion in [Texas] would have resulted in 184,192 fewer depression diagnoses, 62,610 fewer individuals suffering catastrophic medical expenditures, and between 1,840 and 3,035 fewer deaths."
In short, every state that has refused to expand Medicaid should do so as soon as possible, and, as Jon Stewart put it, there's only one real reason to refuse to do so: spite against President Obama.
4. In reality, it costs more not to expand Medicaid than to expand it. The Kaiser Family Foundation found that states (and Washington DC) "that didn't broaden coverage saw their Medicaid costs rise 6.9 percent in the fiscal year that ended Sept. 30. The 29 states that took President Obama up on his offer to foot the bill for expanding Medicaid saw their costs rise only 3.4 percent." Similarly, a 2013 RAND study found that the 14 states that had, at the time, announced their intention not to expand Medicaid actually refused to do so, they would "collectively will spend $1 billion more on uncompensated care in 2016 than they would if Medicaid is expanded." In part this is because states like Texas that refuse to expand Medicaid still have to spent money ($5.5 billion per year for Texas alone) treating the uninsured--money that the state has to cover with taxes rather than taking billions it from the federal government.
5. See the 2012 study above--you know, the one that found that "State Medicaid expansions to cover low-income adults were significantly associated with reduced mortality as well as improved coverage, access to care, and self-reported health", linked here again for your convenience. Now, it's true that the Oregon study reached the opposite conclusion w/respect to outcomes. But this may not mean that Medicaid expansion doesn't work, because the same study found that such expansion was associated with increased "rates of diabetes detection and management, and it reduced observed rates of depression by 30 percent." There are also some limitations to this study, including that it "measured only three health indicators — blood-pressure, cholesterol and glycated hemoglobin levels (which measure diabetic blood sugar control) — and only over a two-year period." Another study estimated that "Medicaid expansion in [Texas] would have resulted in 184,192 fewer depression diagnoses, 62,610 fewer individuals suffering catastrophic medical expenditures, and between 1,840 and 3,035 fewer deaths."
In short, every state that has refused to expand Medicaid should do so as soon as possible, and, as Jon Stewart put it, there's only one real reason to refuse to do so: spite against President Obama.
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