Now that the US Supreme Court has ruled on the Affordable Care Act (ACA), the legal debate over the provision of minimum insurance for all has largely been settled. However, the fiery rhetoric continues to reverberate throughout Congress, and the US is still at loggerheads. “Why?” you ask. The answer is simple; yet somehow still incomplete. The Supreme Court ruled that Congress does not have the authority to penalise states that refuse to expand Medicaid. In response, states such as Texas, Florida, Louisiana and others are standing firm against expanding coverage within their jurisdictions. But the political resistance to providing universal healthcare—particularly when studies show the cost is negligible and the benefits are limited—is still befuddling.
Oddly enough, the benefit of the Medicaid expansion—access to care—has ranked low on the totem pole of ACA criticisms. Instead, the points of contention have revolved around the constitutionality of the reform, or the plan’s ability to tame healthcare costs, or its ability to improve quality of care. As currently planned, the federal government will provide 100% subsidies to expand Medicaid for individuals with incomes up to 133% of the federal poverty level (or US$23,050 for a family of four) for the first three years. This means that states do not have to spend more money in the near term to bring health coverage to more people.
An ongoing study in Oregon that is assessing the impact of providing Medicaid to the state’s uninsured recently found that access to care does not lower costs. Newly-insured individuals spend more on healthcare (an average of US$778/year, or 25% more) than those without insurance. But here is the pièce de résistance—researchers also discovered that those with recently-obtained insurance say they are happier, feel healthier and are more financially stable than before. Though the study focused only on residents of Oregon, it may very well inform the nationwide discussion on ACA.
We can all acknowledge that the ACA will not reduce healthcare costs in the near future. Nor is there compelling evidence to suggest that it will improve quality of care (that has yet to be seen). But hanging over the heads of many—and what states have to struggle with now—is that the ACA increases access to medical care.
What this essentially means is that states that refuse to expand Medicaid will forego insurance for a significant portion of their population. The disservice to them may not be quantified in numbers, but may certainly have an impact on their wellbeing. Without private insurance or Medicaid, these people will seek care back in the emergency rooms—precisely what the ACA is trying to avoid
As an aside, test your knowledge of the ACA here: http://healthreform.kff.org/quizzes/health-reform-quiz.aspx?source=QL
