Thursday, September 10, 2015

Where the states stand on Medicaid Expansion

Many states are still ambiguous towards the expansion of Medicaid.  Twenty-nine states along with the District of Columbia have already expanded Medicaid, the most recent state having agreed to do so being Alaska. However, it is important to note that Alaska lawmakers attempted to stop Governor Bill Walker from expanding the Affordable Care Act’s program, otherwise known as ObamaCare.

Interestingly, four states are looking into expanding Medicaid. They are Montana, Tennessee, Utah, and Wyoming. Montana released an alternative Medicaid expansion plan for a routine public comment period, but it is not likely to be passed. The governor of Tennessee, a Republican, is publicly against ObamaCare, but does intend to use federal funds to provide coverage for an additional 200,000 low-income residents by helping to purchase health plans. This plan was scrapped in February 2015 by a key Senate committee. Utah is still struggling to create a viable plan that could pass in the Legislature, and Wyoming shot down its own expansion plan in February 2015 as well.

Nineteen states have not expanded Medicaid. It is clear that political factions have a role to play in this as many Republican governors have refused expansion. Louisiana Governor Bobby Lindal (Republican) stated that expansion “would cost his state $1 billion over the first 10 years.”

This entire blog post is meant to incite one meaningful question: what are the states’ responsibilities in providing their citizens with healthcare? Are states meant to keep a watchful eye over their citizens, keep the wolves away from the herd, but simply observe passively as the sheep to die from accidental injury and disease? Many countries all over the globe, from Austria to Russia, Hong Kong to New Zealand, provide universal health coverage.  

It is also necessary to note that the article that this blog post is sourced from is clearly inflected with Liberal views. The article provides, ultimately, Liberal propaganda (one example being that the article tended to provide statistics on the amount of people that Medicaid expansion could help, with just enough evidence favoring the Republicans to create a slightly neutral news article). Yes Medicaid will provide subsidies for many Americans who cannot afford expensive healthcare, but do such positive benefits balance out the problems Medicaid expansion could create?

Link to the article here


Caroline Mameesh said...

What I think is interesting to note, and I do credit the blog for mention such aspects rather than swaying too far liberally and neglecting to mention this, is that a few states who have rejected Medicaid's expansion are trying, or so they say, to create their own methods for expanding healthcare. Theoretically, states (such as Texas, South Carolina, and Alabama) are trying to avoid the crisis we talked about in class; being forced, after a few years, to support the ACA themselves.

It is important to realise that, oftentimes, people (and by people, I mean constituents) are driven far more by immediate gain and can neglect to look into the future and down the road. By accepting the funding provided under the ACA, citizens would gain more healthcare coverage, but at what cost? The statistic Daniel quoted, that Louisiana would divulge a whole $1 billion over ten years, is astonishing, because it is clear that $1 billion dollars, being a fantastic sum of money, must come from somewhere. This somewhere will undoubtedly be the tax payers' pockets.

South Dakota took an interesting approach, and frankly, in my opinion, the best approach. Utilising the advantages of federalism, South Dakota is waiting to see how the ACA plays out before implementing it themselves.

All in all, I think the expansion of Medicaid is, at first glance, a wonderful idea in theory. How is it in practice? We'll just have to wait and see, and thanks to Federalism, states can do just that.

Janet Liu said...

Bobby Jindal's statement that expansion “would cost his state $1 billion over the first 10 years," almost seems to be a direct echo of the complaint that had characterized "Cooperative Federalism" and incited the Unfunded Mandates Reform Act.

His statement is also interesting given that (among several science-related honors) Jindal received a postgrad degree in political science with an emphasis on health policy. His thesis? "A needs-based approach to health care." In addition to this, Jindal has served several public offices relating to topics in health, hospitals, and human services. Therefore, I think it's very unlikely that Jindal (and likely many others on the article's list) shut down Medicaid Expansion due to ignorance. This article seems to paint itself as an objective "Medicaid tracker," but the offside is that it pushes public figures into the spotlight, encouraging readers to regard them as a barrier rather than players in the political game between the states and the federal government.

In Jindal's case, the game has very likely been exacerbated, too, by Louisiana's budget problem as of late.

A fun piece about Jindal and Louisiana spiked with Kevin Drum's sass...

So Jindal probably thinks that universal healthcare would be great. But when he's got people to placate and a budget to balance, sticking to a "noble" position is understandably harder. I think cases such as these really highlight why understanding the nuances of national mandates, and unfunded albeit well-intentioned mandates in particular, is extremely important.

What might this record bode for Jindal's 2016 campaign trail...?

Monika Kepa 1 said...

This seems to go back to the universal debate of these types of things. Do we want benefits--yes, do we want to pay for them--not really. Think about it this way someone has to pay and if an open heart surgery can cost around $324,000 and with heart disease as the leading cause of death in the US this is more common than would be comfortable. Plus this cost is just for the procedure, not the before, the stay or the PT. A billion in ten years might seem like a lot but so is over $350,000 for one family. Healthcare costs for the rich poor and the older. Yet I have been told that although no one can be turned down for obamacare and more people are getting insured not every hospital, doctor or procedure will take it; therefore many people are getting an insurance that will not help them in case of an actual emergency.

Crystal Lee said...

Although the federal government perhaps possesses the power to provide universal healthcare (see: Congress possesses the power to make laws in order to guard the welfare of American citizens; surely welfare includes health?), maybe it's in the citizens' best interests for that power to be delegated to the states. If states each designed their own healthcare plans, theoretically, the theorized benefit of state power would come into play: the ability to be more responsive to the constituents of that state, as opposed to the federal government's responsibility to cater to the entire nation.

However, there is no denying that government-subsidized healthcare places a strain on budgets, as mentioned by the governor of Louisiana. So, if that's the case...maybe this is where the federal government comes in. If the federal government provides the funding, and the states carry out the laws themselves in what would hopefully be an example of cooperative federalism, then maybe even the mostly anti-ACA governors/states (that is, many Republicans, since, as the blog post mentioned, the argument about the ACA is highly politically-colorized) would be able to implement healthcare through state legislatures, similar to what the anti-ACA, Republican, Tennessee governor wishes to do.

Also, going back to the blog's final comparison of the United States to other countries which provide universal healthcare, the United States situation can be said to be different because of the federal system in place here and the resulting power dynamics between the state and the federal government.