Wednesday, August 16, 2017

The ACA and working America: Medicaid in Oklahoma

We checked through our notes and uncovered the couple we talked about in our last post. They live in Oklahoma, so we looked up up ACA information for that state.[1]

Estimated 2017 household incomeSavings programs you may qualify for
Below $16,020Since your state hasn't expanded Medicaid, you won't qualify based purely on income. You also won't qualify for financial assistance on a health insurance plan.
$16,020 - $40,050A health plan with lower monthly premiums PLUS extra savings.
$40,051 - $64,080A health plan with lower monthly premiums.
Above $64,080You won't qualify to save on a health insurance plan. You can buy insurance through the Marketplace at full price.

If they could not afford insurance because their $100 a month, $1,200 a year, was over a fixed limit, it could be they were only earning $17,200 a year ($16,000 to qualify for Medicaid, plus the $100 a month). In that case, all that had to happen for the ACA to work for them was for Oklahoma to accept Medicaid expansion.

In an earlier post we said we states decided whether or not to expand Medicaid based on politics. The split in states is pretty much along party lines. Nevertheless, for those states which are poorer, expansion poses a problem as even the eventual ongoing 10% co-pay could make budget deficits worse or cause a state to fund its share of expansion by cutting Medicaid in other areas. This issue is compounded at the funding level because Medicaid is a combined federal and state program. While all states are required to meet a minimum coverage requirement, states which can afford and provide more care also receive more federal funding — Medicaid works on a formula of funds matching, with the larger portion picked up by the federal government. So, the states which can provide more multiply the funding they have to take care of their neediest, while those states which struggle to get by wind up with even less.

Republicans talk about "block grants" to states, which "know the needs of their citizens" the best. But is it a question of knowing what's best, or forcing states which aren't as well off to make hard decisions which mean taking benefits away from one group to fund those of another. Block grants would not change the fundamental way in which funding is determined in the first place or alleviate disproportional aid to states.

Perhaps Medicaid should be a Federal program, so that all Americans can receive the same level of benefit? Expansion for all and uniform levels of support and subsidy without penalizing current Medicaid recipients at the state level only makes sense. The care we provide to our neediest shouldn't depend on how well a state did in its budget year to year.

[1]At, selecting a household of 2 in the state of Oklahoma, retrieved 16-August-2017.
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