Medicaid Works: Citizens Lose when States Opt Out —- Graphic Credit Adam Cole, NPRHealth Policy Debate, Highlights of the Month Monday, August 27th, 2012
Medicaid Works: Citizens Lose when States Opt Out
By Caryn Sever
Beginning in 2014, every state will have the option to expand Medicaid coverage to any adult whose income is more than 133% below the poverty line (a little over $31,000 for a family of 4). At least 5 states, including Florida, Louisiana, Mississippi, South Carolina, and Texas will choose not to participate. Five other states are leaning towards not participating, and 27 states, including Virginia are currently undecided. This means that the majority of the United States is either not going to participate or is currently undecided about the expansion. On August 23rd, The Commonwealth Fund released a blog post explaining why Medicaid works, and what it means for these states to opt out of expansion. “Medicaid Works: Public Program Continues to Provide Access to Care and Financial Protection for Society’s Most Vulnerable” written by Karen Davis, President of the Commonwealth Fund and Kristof Stremikis, a senior researcher for the Commonwealth Fund, outlines the need and benefits of Medicaid expansion as dictated by the Affordable Care Act (ACA).
According to the new projections released by the Congressional Budget Office, about “30 million previously uninsured Americans will gain coverage by 2022, 3 million fewer than had been predicted after the law was passed but before the Supreme Court decision.” Furthermore, as per the ACA, the primary reason for trimming the annual payments to hospitals under Medicare was to compensate hospitals for the unrecoverable debts of previously uninsured patients.  This means that these adjustments will generate billions of dollars to help finance the expansion of coverage. Davis and Stremikis fear that repealing the coverage provisions, while maintaining the reduced payments would render it quite difficult for the hospitals to take on the debt that comes from providing care to the uninsured. “Repealing the law would increase the federal deficit by $109 billion over the next decade.” 
All money aside, there is a reason that Medicaid and Medicare exist. In 1965, when President Lyndon B. Johnson signed the programs into law, it was done so in response to meet the health care needs of the elderly and poor.  In his introduction of LBJ, President Harry Truman remarked “I am glad to have lived this long and to witness today the signing of the Medicare bill which puts the Nation right where it needs to be to be right.”  Johnson himself explained “There are more than 18 million Americans over the age of 65. Most of the have low incomes, most of them are threatened by illness and medical expense that they cannot afford. And through this new law, Mr. President [Truman], every citizen will be able, in his productive years when he is earning, to insure himself against the ravages of illness in his old age.” Now, 47 years later states are debating expansion over an ever growing populous.
States that chose to opt out of the expansion are doing their citizens a disservice in several ways. Not only would the health of their state suffer, but resisting the expansion places a heavy burden state hospitals as well as “keeping the medically underserved community from receiving an enormous economic infusion”.  All the evidence points to the fact that expansion will save both the state and federal government’s money so even if certain states choose not to expand, the residents of each state will still be paying federal taxes to cover the expansion of those states that chose to opt in.
The facts stand for themselves, Medicare and Medicaid saves lives. In a study on Medicaid enrollment in Oregon, it was found that participants who receive coverage through the program were able and more likely to visit the doctor than those without coverage. In another study conducted by Harvard’s School of Public Health, it was found that states with Medicaid expansion showed a 6.1 percent decrease in deaths, or roughly 2,840 per year for every 500,000 US adults.  The study compared New York, Maine, and Arizona five years before and after expansion while comparing them with four neighboring states that had no Medicaid expansion. The United States Census Bureau recorded the US population in 2012 at 314,226,708 judging by the results of this study that means that Medicaid expansion saved about 1,784,807.70 people per year. This public program is critical to vulnerable populations such as the poor and elderly, who require public programs to survive and thrive. When states opt out the citizens suffer, the burden falls to the population who lose out on building a strong health care system with the funds specifically allotted for this purpose.