States should embrace Medicaid expansion under any conditions. But now, more than ever due to the pandemic, it is a moral and economic imperative, write Gabe Scheffler and Allison Hoffman in an op-ed.
President Trump is largely deferring to states to address the rapid spread of COVID-19, and 14 states now have an especially good opportunity to save lives, and money in the process. They have at their fingertips an offer of federal money to pay for life-saving health care for their poorest residents through Medicaid. Yet, these states have so far refused this lifeline, even though the coronavirus pandemic makes having everyone insured more urgent.
Historically, federal Medicaid dollars were only for specific populations, such as low-income children and their parents, the disabled, and pregnant women. The ACA did away with these categories. It required states to expand their Medicaid programs to cover all low-income adults (defined as an individual earning up to around $17,600 in 2020). In turn, the federal government would pay the lion’s share of the costs for medical care for the newly eligible expansion population. After a 2012 Supreme Court decision made the mandatory expansion optional, most states embraced this opportunity.
Fourteen states, including Florida, have not, meaning they continue to refuse a huge pot of federal money to pay for health care for their poorest residents. It is hard to understand exactly why. Some states might genuinely be concerned that the federal funding will dry up, eventually leaving them holding the bill for the expansion population. And some might be unable or unwilling to raise the state’s share of the cost, even though it is now only 10% of total medical care costs. But mostly, the refusal seems rooted in narrow notions about who are the “deserving poor” worthy of government help, the misguided belief that Medicaid beneficiaries should just get a job despite the fact that most already work, racism and xenophobia, and pure partisan politics. As a result, over two million Americans who would otherwise be eligible for Medicaid are left with no access to health insurance coverage during this public health crisis.
Florida has the third-largest uninsured population of any state, with over 2.7 million uninsured in 2018. A recent report concluded that full implementation of the Medicaid expansion in Florida would mean around 400,000 additional people would gain access to health insurance. That number is growing as people are joining the ranks of the unemployed and losing their employer-provided insurance.
Many of these people will need medical care in the coming days, weeks, and months. The number of coronavirus cases in Florida continues to rise, bringing the case count to over 29,000 confirmed cases. Some people will get the emergency care they need despite being uninsured, but will then be left to dig out from under a mountain of medical debt. Stories of coronavirus debt are quickly coming to light. One uninsured woman in Massachusetts was recently charged nearly $35,000 after getting tested for COVID-19 and making a few trips to the emergency room. Estimates of the costs of a COVID-19 hospitalization are as high as $72,000 for people with insurance. Bills could be higher for the uninsured. Other uninsured people will forgo seeking medical care out of fear that the resulting bill will be worse than the physical consequences of not seeking care. Some will die as a result.
Expanding Medicaid would offer these Americans a lifeline. The Medicaid program is uniquely suited to address a public health crisis like the coronavirus pandemic: it targets the low-income population who are likely at especially high-risk of contracting — and dying from — the virus and provides comprehensive coverage with little or no cost to the person who falls ill. Research shows that expanding Medicaid improves financial security, increases access to essential medical care, and saves lives. States should embrace Medicaid expansion under any conditions. But now, more than ever, it is a moral and economic imperative.