To: President Donald Trump
Closing the Medicaid Expansion Gap
President Obama: Please Close the Medicaid Expansion Gap by a Presidential Executive Order.
The Affordable Care Act was designed to provide health insurance to most Americans by expanding Medicaid to cover people with incomes up to 138% of federal poverty level, and compelling those with incomes above 138% of federal poverty level to purchase health insurance (with subsidies available for incomes from 138% to 400%).
However, the Supreme Court decision which upheld the Affordable Care Act made the Medicaid expansion a state by state decision by preventing the federal government from tying the Medicaid expansion funds to the funding of the preexisting Medicaid programs. So far, 22 states have rejected the Medicaid expansion funds despite the fact that the Federal government will fund the expansion 100% for the first 3 years, after which the level of federal funding drops gradually to 90% in 2020 and then stays at 90%.
As a result of the decision of these states, the uninsured poor people living in these states will have no realistic options for obtaining health insurance despite the Affordable Care Act. These are people earning under 100% of federal poverty level who do not qualify for Medicaid under the current eligibility criteria in those states. People earning under 100% do not qualify for subsidies under the ACA. There are about 5 million people who fall in this category, mostly in the Southern states because the current Medicaid qualification eligibility criteria in those states are stringent. These are Americans who remain at risk for avoidable death, disability and financial ruin despite the Affordable Care Act.
The state of Arkansas is expanding Medicaid by using the federal Medicaid expansion funds allotted to it to buy private insurance for the newly eligible individuals. The President can use this model to provide insurance for the newly eligible citizens living in other nonexpanding states. The Secretary of Health and Human Services should be directed to assist the newly eligible individuals living in the nonexpanding states to obtain private health insurance through the federal exchange or with the assistance of the navigators and the hospitals in those states. The federal government will then pay the premiums using the funds already allocated for Medicaid expansion in those states. The hospital associations in the affected states are ready to provide whatever assistance is necessary to help this population gain health insurance.
This should be done by Presidential Executive Order. There are some decisions that are too important to be left to the states. That is why the Emancipation Proclamation was a Presidential Executive Order. The poorest people in the poorest states in the richest country in the world should not be left without access to health care. This situation is a moral tragedy and a stain on the conscience of the nation. This is about the content of our character and the values of the nation. It is about the struggle for a more perfect nation. It is about the fight for the dignity of all people.
The Medicaid expansion gap must be closed and it can only be closed by a Presidential Executive Order. President Obama should act now.
The Affordable Care Act was designed to provide health insurance to most Americans by expanding Medicaid to cover people with incomes up to 138% of federal poverty level, and compelling those with incomes above 138% of federal poverty level to purchase health insurance (with subsidies available for incomes from 138% to 400%).
However, the Supreme Court decision which upheld the Affordable Care Act made the Medicaid expansion a state by state decision by preventing the federal government from tying the Medicaid expansion funds to the funding of the preexisting Medicaid programs. So far, 22 states have rejected the Medicaid expansion funds despite the fact that the Federal government will fund the expansion 100% for the first 3 years, after which the level of federal funding drops gradually to 90% in 2020 and then stays at 90%.
As a result of the decision of these states, the uninsured poor people living in these states will have no realistic options for obtaining health insurance despite the Affordable Care Act. These are people earning under 100% of federal poverty level who do not qualify for Medicaid under the current eligibility criteria in those states. People earning under 100% do not qualify for subsidies under the ACA. There are about 5 million people who fall in this category, mostly in the Southern states because the current Medicaid qualification eligibility criteria in those states are stringent. These are Americans who remain at risk for avoidable death, disability and financial ruin despite the Affordable Care Act.
The state of Arkansas is expanding Medicaid by using the federal Medicaid expansion funds allotted to it to buy private insurance for the newly eligible individuals. The President can use this model to provide insurance for the newly eligible citizens living in other nonexpanding states. The Secretary of Health and Human Services should be directed to assist the newly eligible individuals living in the nonexpanding states to obtain private health insurance through the federal exchange or with the assistance of the navigators and the hospitals in those states. The federal government will then pay the premiums using the funds already allocated for Medicaid expansion in those states. The hospital associations in the affected states are ready to provide whatever assistance is necessary to help this population gain health insurance.
This should be done by Presidential Executive Order. There are some decisions that are too important to be left to the states. That is why the Emancipation Proclamation was a Presidential Executive Order. The poorest people in the poorest states in the richest country in the world should not be left without access to health care. This situation is a moral tragedy and a stain on the conscience of the nation. This is about the content of our character and the values of the nation. It is about the struggle for a more perfect nation. It is about the fight for the dignity of all people.
The Medicaid expansion gap must be closed and it can only be closed by a Presidential Executive Order. President Obama should act now.
Why is this important?
As a physician in the state of Georgia, I have seen first hand the results of lack of health insurance.
I have seen people with high blood pressure who develop heart failure and strokes because they cannot afford their blood pressure medications. I have seen people with diabetes who go on to develop kidney failure because of inadequate care. Many of these are the working poor - cooks, cashiers, cleaners, decent people who are working hard to make ends meet. They should not be left at the risk of unnecessary death, disability and financial ruin in the United States of America at this day and age despite the passage of the Affordable Care Act.
The richest country in the world should not be the only developed country in which the poor do not have guaranteed access to healthcare, something that citizens of all other developed countries take for granted.
I have seen people with high blood pressure who develop heart failure and strokes because they cannot afford their blood pressure medications. I have seen people with diabetes who go on to develop kidney failure because of inadequate care. Many of these are the working poor - cooks, cashiers, cleaners, decent people who are working hard to make ends meet. They should not be left at the risk of unnecessary death, disability and financial ruin in the United States of America at this day and age despite the passage of the Affordable Care Act.
The richest country in the world should not be the only developed country in which the poor do not have guaranteed access to healthcare, something that citizens of all other developed countries take for granted.