Medicaid expansion under the Affordable Care Act is contentious- mostly because Republicans don’t want to give President Obama any credit- for anything. But if this study, reported today by the New York Times, is any indication, not going forward could be deadly.
Into the maelstrom of debate over whether Medicaid should cover more people comes a new study by Harvard researchers who found that when states expanded their Medicaid programs and gave more poor people health insurance, fewer people died.
The study, published online Wednesday in The New England Journal of Medicine, comes as states are deciding whether to expand Medicaid by 2014 under the Affordable Care Act, the Obama administration’s health care law. The Supreme Court ruling on the law last month effectively gave states the option of accepting or rejecting an expansion of Medicaid that had been expected to add 17 million people to the program’s rolls.
Seems fairly reasonable. So why would anyone reject the expansion?
Medicaid expansions are controversial, not just because they cost states money, but also because some critics, primarily conservatives, contend the program does not improve the health of recipients and may even be associated with worse health. Attempts to research that issue have encountered the vexing problem of how to compare people who sign up for Medicaid with those who are eligible but remain uninsured. People who choose to enroll may be sicker, or they may be healthier and simply be more motivated to see doctors.
The New England Journal study reflects a recent effort by researchers to get around that problem and allow policy makers to make “evidence-based decisions,” said Katherine Baicker, an investigator on the study who served on former President George W. Bush’s Council of Economic Advisers.
“I think it’s a very significant study in part because of the paucity of studies that have really looked at health outcomes of insurance coverage,” said Karen Davis, the president of the Commonwealth Fund, a nonpartisan research foundation. “Actual mortality studies are few and far between. This is a well-done study: timely, adds to the evidence base, and certainly should raise concern about the failure to expand Medicaid coverage to people most at risk of not getting the care that they need.”
A Republican-appointed official calling this “evidence based”- will it be enough? Probably not. But the evidence is still there:
“So often you hear, ‘Oh well, poor people just shoot each other, and that’s why they have higher mortality rates,’ ” said Diane Rowland, executive vice president of the Kaiser Family Foundation, a nonprofit group. “In the midst of many claims about what Medicaid does and doesn’t do, it actually shows that it cannot only be beneficial for health, but in preventing some of the premature deaths of the uninsured.”
Janet M. Currie, director of the Center for Health and Well-Being at Princeton, said the new study, combined with the Oregon research, should help transform the Medicaid debate into one about dollars, rather than over whether covering poor people improves health.
“This says, well there is benefit to giving people insurance,” Dr. Currie said. “Maybe you don’t want to pay the cost, but you can’t say there’s no benefit.”
- Medicaid Expansion Likely to Lower Death Rates, Study Says (nytimes.com)
- CBO: If States Opt Out of Medicaid Expansion, $84B Saved (crooksandliars.com)
- CBO Confirms: The Health Care Law Reduces the Deficit (whitehouse.gov)
In 10,000 Same Sex Couples Magazine, an excellent overview of the benefits of the ACA for LGBT persons. Excerpt:
Nondiscrimination protection measures have been included in the Affordable Care Act, and significantly, by 2014, insurance companies will not be able to deny coverage based on pre-existing conditions such as HIV or transgendered medical history.
Increased services for preventive care and HIV testing and treatment have been included in the ACA. As insurance companies will no longer be able to cancel or deny coverage based on pre-existing conditions, Americans living with HIV will have better access to care and to life-saving drugs, whereas currently, an estimated 25% of the 1.2 million Americans living with HIV in the United States have no health insurance coverage. Many of those living with HIV without insurance, or with insurance but consistently fearful of having it canceled due to a pre-existing condition, have been forced to pay out of pocket or seek other methods of treatment.
LGBTQ Activist Chris Barnett of San Francisco says: “I’ve been fortunate to have health coverage all my years of living with HIV, so pre-existing condition has thankfully never directly affected me. Though I must say, in my early years with this, late ’80s to early ’90s, I was fearful of using my insurance for fear of being redlined, so I paid for early treatment out of pocket, or found medical studies.”
As most states in America fail to recognize same-sex relationships, healthcare through a spouse’s workplace is not an option for many LGBTQ Americans. This often results in a high number of citizens forced to pay high prices for private insurance or to forgo having any insurance at all due to cost. With ACA’s expansions to the affordability and accessibility of healthcare, more LGBTQ Americans will be able to be covered.
Just as I suspected. If Mitt Romney wants to (as he claims) overturn Obamacare, it’s going to cost the taxpayers billions of dollars to rollback the healthcare changes already underway. Not to mention the debt cliff that he will need the cooperation of Democrats to negotiate.
Ryan Lizza from the New Yorker:
Mitt Romney, speaking just before noon today, declared that on his first day in office, “I will act to repeal Obamacare.” I think he chose his words carefully. As President, he may indeed “act” to repeal it on Day One, but I don’t believe he will actually be able to overturn the law.
If Romney were to win in November, the first matter he’d have to deal with would be the fallout from the so-called fiscal cliff of December 31st, the day when some five hundred billion dollars worth of tax increases and spending reductions take effect, which could put the economy into another recession (if it’s not already in recession by then). This moment would perhaps be Romney’s greatest chance at repeal. Because the fiscal-cliff negotiations will be an enormous fight over the size and scope of the federal government, every government policy will theoretically be open to debate—including, Romney might insist, repeal of the A.C.A.
But it’s a fantasy. The negotiations would be dead before they started if Republicans demanded repeal as a price for a Grand Bargain on taxes, spending, and entitlements. The fiscal-cliff negotiations will undoubtedly include a great deal of horse-trading that will infuriate and cheer partisans on both sides. But there is literally nothing Republicans could offer Democrats in return for repealing the Party’s greatest achievement since the Johnson Administration.
The reality of the huge (enormous) cost of repeal will pull the bloom off the rose PDQ. It’s insanity.
- Why Romney Won’t Repeal Obamacare (newyorker.com)
- Michele Bachmann: It Only Takes 50 Plus One Senators to Repeal Obamacare (Video) (thegatewaypundit.com)
- Why Repealing Obamacare is a Fantasy (politicalwire.com)
- If Romney wins, he can repeal health reform. And he should. – Washington Post (blog) (washingtonpost.com)
- Constitutional Defiance: Romney Says He’ll Repeal ObamaCare (thenewamerican.com)
- Supreme Court OK of Obamacare is a huge gift to Romney and GOP (irishcentral.com)
Wondering about the Supreme Court’s decision on HIV/STD prevention and care? Some help from The National Coalition Of STD Directors:
As you consider the impact of today’s Supreme Court ruling on the Affordable Care Act on different populations, I would like to share with you the impact of today’s ruling on our fight to prevent and treat sexually transmitted diseases.
Sexually transmitted diseases (STDs) remain a major epidemic in the United States. Each year, there are approximately 19 million new cases of STDs, approximately half of which go undiagnosed and untreated[i], giving the United States the highest STD rate in the industrialized world.[ii]
STDs cost the U.S. health care system $17 billion every year—and cost individuals even more in immediate and life-long health consequences, including infertility, higher risk of acquiring HIV, and certain cancers.[iii]
- Young people will continue to have expanded coverage under their parent’s insurance. Young people bear a disproportionate burden of STDs—those aged 15-25 make up half of the STDs contracted annually, but make up only one-fourth of the sexually active population.
- Private insurance will continue to have to cover prevention services with no cost out-of pocket costs to patients. Many of those who visit STD clinics are low-income and would not be able to receive prevention sexual health services without coverage by insurance. While there is still work to be done for certain at-risk populations, such as men who have sex with men, expanded STD testing and STI counseling will be covered by insurance under this expansion of preventative care in the law and it is a great start.
- The continued need for safety-net service providers is underscored. With the narrowing of the Medicaid expansion provisions, the very real possibility exists that many low-income individuals will not have access to affordable health care coverage. Patients at STD clinics are young, minority, and poor—populations that are bear a much higher burden of STD disease—and may be left without coverage in a state that may choose not to expand their Medicaid coverage.
HIV-specifics from Lambda Legal:
“This is a victory for all Americans, but in particular, the Court’s decision today will save the lives of many people living with HIV – as long as states do the right thing. The Affordable Care Act will finally allow people living with HIV to access medical advancements made years ago but that have so far remained out of reach of many. With continuing prevention education, early detection, and quality care for everyone living with HIV, we have the power to stem the HIV/AIDS epidemic.
“But this is not a complete victory, because today’s decision allows states to opt out of the Medicaid expansion that would provide insurance coverage for many low-income people who cannot otherwise afford it. Our continuing challenge will be to make sure that states opt to expand Medicaid so that more low-income people, and particularly those with HIV, can get the health care they urgently need.”
- Who should go for a STD test? (healthnfitnesstips.typepad.com)
- Teens don’t identify with STD messages (futurity.org)
- Affordable Care Act a lifeline for people with pre-existing conditions (king5.com)
- Obama: ‘National HIV Testing Day highlights the importance of HIV testing and the fight against HIV/AIDS’ (miamiherald.typepad.com)
(We) believe that a civilized society must ensure the provision of basic healthcare to its citizens regardless of their ability to pay for it. (We) further believe it is a moral imperative that all levels of government institute programs that ensure the poor receive such care. (We) believe Medicaid expansion under the Act is critical to the communities (we) serve.
Predictably, some “Catholic” websites are leading with headlines like “Liberal Nuns Support Obamacare”, and “Liberal Activist Nuns Want Socialized Medicine”.
Sigh. What’s wrong with these people? What do they think Jesus would charge for healthcare? And they’re theologically out of step with their church.
As further proof that conservative efforts to paint President Obama as the enemy of religion are a red herring, nearly two dozen leading Catholic nuns filed a brief in the Supreme Court last week supporting the president’s signature legislative accomplishment. The Catholic sisters who joined the brief include the leaders of many prominent religious orders providing health care and other services to the needy.
These nuns have unique stature to explain why their support for the Affordable Care Act flows from their faith, given that so many of them have devoted their lives to providing care to those most in need. Nevertheless, their views are hardly unique within their church’s hierarchy. Pope Benedict XVI called health care an “inalienable right,” and added that it is the “moral responsibility of nations to guarantee access to health care for all of their citizens.”
Duh. “Is the Pope Catholic?” may no longer be a rhetorical question- especially for catholic fanatics.
Oh- and Jesus healed for free….
- Rick Santorum Tries To Explain Why He Does Not Agree With The Catholic Church On Health Care Reform (thinkprogress.org)
- Often Overlooked, Sisters on The Forefront Of Equality (dgsmith.org)
- The Nail On The Head (dgsmith.org)
- Catholics defend The President (From Eternity To Here)