The idea of Medicaid expansion was initially received by the common American population with mixed reviews. Some thought it was a great idea, and wondered why nobody had thought of it sooner. Others thought it was a terribly idea, and wondered why people did not get a job and pay for their own insurance. The proposal was made with the common, impoverished American in mind. The expansion was federally funded, likely to coerce as many states as possibly into expanding Medicaid for their populations. In states that adopted it, the expansion offers healthcare to all men, women, and children living below the poverty level who cannot afford insurance or healthcare out of pocket. It is critically important, of course, that these individuals receive healthcare in spite of the fact they are impoverished. The significance of Medicaid expansion comes in many forms. To begin, it insures the uninsurable, offering them a chance at a normal life. Due to its infinite federal funding on some level, it has the capacity to teach Americans a thing or two about compassion healthcare. Lately, however, it appears its most significant value was to be dividing a country economically.
The economics of Medicaid expansion are far more complicated. States that have already expanded recognized they could afford to do so at the time, and gambled they could continue to afford it based on the money they would save not only on healthcare costs, but preventative care. Other states have voted to expand Medicaid now that they see it is working. However, several state budgets are on shaky ground due to the expansion for two reasons since the expansion. Many states are in trouble primarily because they are overwhelmed with citizens collecting pensions, and the healthcare delivery owed to former government employees. The second reason budgets are in trouble is an increasing demand for funds based on Medicaid expenses, sometimes in other states. What some fail to realize is Medicaid expansion is federally funded, and will continue to be federally funded by 90% as it tapers off in 2020. This means all state budgets must be reconfigured to suit the needs of the expansion and while some states are not reaping the rewards, all states are paying for it.
It seems logical to vote yes on the expansion if the citizens of every state are going to be paying for it anyway, but some states have still voted it down. Florida is one of the most precarious states, as their Senate and House officials are locked in a vicious battle concerning whether to expand or not. Unfortunately, the problem is likely to only get worse as time goes on; budgets will wear thinner as states are expected to pick up more of the slack for a growing population. As this happens, states that are unable to compensate for the growing monetary need will be unable to satisfy the federal mandate. Furthermore, they will be unable to continue meeting typical standards in their own states.
Most unfortunately, the allocation of care has been impacted by the interlock of this healthcare and economic train wreck. Many states who continuously vote yes on proposals that will send the entire country into an economic tailspin are just as to blame as states that only do it once. The result is states like Florida, North Carolina, and Arkansas being forced to stop what are considered to be vital healthcare programs, such as preventative screenings at cost or for free, healthcare education in low-income areas, and the closing of clinics in areas that need it most. Healthcare is not all that is affected, especially when a state’s budget runs low. The entire infrastructure of the state begins to crumble, as county services, pensions, and education, also feel the effect of a weakened economy. A new or more reasonable proposal has yet to be announced, leaving states scrambling to pay for the basics.
References
Dalal, M. (2016). To Expand or Not To Expand? The Role of Elite Framing in the Politics of Post-ACA Medicaid Expansion. Ann Arbor: The University of Michigan.
Minkler, M. (2014). Community Organizing and Community Building for Health and Welfare. New Brunswick: Rutgers University Press.
