Medicaid expansion on chopping block in SCOTUS case
By Erin Durkin for National Journal.
As the Affordable Care Act heads to the Supreme Court on Tuesday, a key program that has provided coverage to 12 million low-income Americans is on the line.
Medicaid expansion, a program that has provided coverage to 12 million Americans and reduced health disparities, could come to an end during a global pandemic and economic recession.
Like the rest of the Affordable Care Act, the future of Medicaid expansion is on the chopping block as it heads to the Supreme Court on Tuesday. Several Republican state attorneys general and the Trump administration are asking for the high court to invalidate the entire law.
The program allows states to extend Medicaid coverage to individuals making up to 138 percent of the poverty level. So far, this has provided coverage to 12 million people who would not have qualified for the program before the Affordable Care Act, with the federal government footing 90 percent of the bill. Medicaid expansion has been credited fornarrowing health disparities and yielding savings for states.
Experts told National Journal that ripping the Medicaid expansion away as more people turn to the program for health coverage would be devastating.
“It would take health care coverage away from 12 million people, a number that’s likely actually going to be larger by then, just because more states will have brought expansion online and enrollment will have ticked up because of the recession,” said Jesse Cross-Call, senior policy analyst at the Center on Budget and Policy Priorities. “I think the human cost is pretty severe.”
A ruling on Tuesday’s case could take months to decide and come in late June, and there is evidence that Medicaid enrollment, including in the expansion population, is growing.
Recent data from the Centers for Medicare and Medicaid Services found that Medicaid enrollment increased 6.2 percent between February and June. Analysis by the Centers for Budget and Policy Priorities found that enrollment for the Medicaid-expansion populations in 17 states increased by almost 13 percent between February and July.
The Congressional Budget Office estimated in September that the number of people enrolled in Medicaid expansion will grow to 13.7 million people in 2021. The Urban Institute in an Oct. 15 report suggested that overturning the ACA would result in at least a 90 percent increase in the uninsured population for 25 of the expansion states.
Cross-Call added if the federal money through Medicaid expansion were taken away, states would not be able to fund coverage for the expansion population. “The federal government obviously pays 90 percent of the cost,” he said. “Even in strong economic times, this wouldn’t be something that states could just scrounge up their own dollars to fund if the federal government took away its funding. In a recession, they certainly can’t do it.”
Along with providing coverage to more low-income individuals, Medicaid expansion has also helped narrow racial and ethnic health disparities, a problem that has been intensely pronounced by the COVID-19 pandemic. Experts argue this progress could be reversed if the ACA is invalidated, Medicaid expansion included.
“To take away these coverage options, particularly during the global pandemic and recession, would exacerbate the racial and ethnic inequality in California,” said Amy Adams, a senior program officer for the California Health Care Foundation’s Improving Access team. “It would have devastating effects on communities that are severely and disproportionately affected by the pandemic and the recession.”
A Kaiser Family Foundation analysis says that among the nonelderly population, one in three Black, Hispanic, American Indian and Alaska Native people are covered by Medicaid.
“Loss of the Medicaid expansion, in particular, would likely lead to disproportionate coverage losses among people of color, contributing to widening disparities in coverage, access to and use of care, and health outcomes,” wrote Samantha Artiga, who heads the Racial Equity and Health Policy Program at the Kaiser Family Foundation, in the October report.
While the economic impact of Medicaid expansion varied by state, several found that it yielded savings before the pandemic, said Matthew Buettgens, senior fellow for the Health Policy Center at the Urban Institute. He added that expansion dollars can help boost state economic activity and employment.
“Basically, if more people have health coverage, then that means there’s more spending on health care services and there’s more federal dollars flowing into the state,” said Buettgens. “That drives economic activity and employment directly. Money spent on health care services, a larger share of that stays in the state than spending on other goods and services.”
The UC Berkeley Labor Center released an analysis last month finding that 269,000 jobs would be lost in California if the ACA is overturned. Almost 60 percent of the jobs lost would be from the health care sector, including hospitals, clinics, and doctor’s offices.
Ending the Medicaid expansion would take a toll on state economies during a time when they will likely still be recovering from the turmoil caused by the pandemic.
“Because there’s no longer have that safety net, you’re no longer drawing down those federal dollars, like it’s a loss of funding, it’s a loss of funding that’s being spent in the state in terms of Medicaid but also of course the marketplaces and their subsidies as well,” said Edwin Park, research professor at the Georgetown University McCourt School of Public Policy. “You’re withdrawing that money from the economy, you know when there’s a downturn because of COVID, that makes the economic situation that much worse.”