Now that the Affordable Care Act has been cleared constitutionally by the Supreme Court, it’s up to States individually to decide if they wish to use the monies set aside for expansion of their existing Medicaid programs, or some variation thereof (like subsidizing purchase of regular insurance), to cover low-income individuals who otherwise could not afford health coverage. Currently, many State programs cover only children & folks on disability.
A number of States have accepted the money; a few States, my own included (Florida), have refused it. To learn why, I wrote my legislators asking their reasons for turning away those dollars, in our case $51B over 10 years to cover the approximately 1.2M uninsured here; what follows are the reasons, similar to those heard around the nation by others who have refused to participate:
- By refusing the money, it will go back into the general US treasury and help reduce the deficit (folks for the expansion claim the monies, taken from FL taxpayer dollars, will just be used by other States);
- We don’t trust the Feds to live up to this stated commitment, so we’re afraid we’ll be on the hook for the expansion when they renege down the line;
- Our current Medicaid system is terribly dysfunctional, so we don’t want to be forced to expand it.
Something just didn’t seem right to me, so I fact checked their reasoning; here’s what I discovered:
- The way the law is written, the monies for it are in a separate fund (not the general treasury), coming from a combination of new taxes on wealthier Americans, fines from companies/individuals who don’t adhere to it, and projected savings from folks no longer using uncompensated emergency room care, instead using the regular system (less costly) thus improving their health outcomes (also reducing costs); monies refused by States go back into this fund to be used for future health care, not into the general treasury to reduce the deficit nor to other States currently willing to accept these dollars;
- Although the feds are notorious for their “unfunded mandates” (eg passing a law without dollars behind it for enforcement), the federal government has never stopped paying on its medical obligations (Medicare/Medicaid), nor anything for which funding has been allocated;
- Many State Medicaid systems are in fact quite poorly run (and so underfunded that no decent doctors will participate) which is why alternatives like subsidizing the purchase of regular insurance is an option that can be permitted (the option forwarded by a FL legislator who believes in using the federal dollars – he’s Republican btw); no State is being compelled to simply expand their current faulty Medicaid system.
Knowing the facts is particularly germane to we Boomers, because many of us are without health insurance, not on disability, and quickly falling into (or already in) the category of adults who qualify for this expansion of State health benefits. About 8.6 million of us in fact, who were found to be without health insurance according to a special 2009 report by Commonwealth Fund. As a result of the Great Recession coupled with ever increasing health care costs, Boomers caught between drastically shrinking retirement accounts and high Boomer unemployment (with the lowest rate of re-employment) are the biggest casualties.
So, Boomers – a generation known for its high rates of diabetes, heart disease, and obesity – living in States refusing expansion of more affordable care to a larger number of their citizens, are the group to be hardest hit by such decisions. Next are our many adult children who are unable to find work offering benefits, in a system that relies solely on such employer-based access for the most affordable coverage.
As you determine your position on this issue, may the facts be with you.