Medicaid expansion decreased the uninsured adult population by millions from 2010 to early 2016. The gains made in insuring non-disabled adults who are at or near the poverty level will be halted or reversed under a Trump administration. Disabled adults and children will likely maintain coverage, but it may not be at the same level. However, low-income, non-disabled adults and the working poor may lose health care coverage.
The Affordable Care Act (known as Obama Care) allowed states to expand Medicaid to adults whose incomes are at 138 percent of the poverty level. The Federal government covered the cost for three years. Thirty-one states (and the District of Columbia) opted in when the legislation was passed in 2010, and 19 did not. As of 2017, states must begin contributing five percent toward the cost and by the year 2020, 10 percent is mandated, per NPR News.
In the state of Kentucky, enrollment doubled since 2013, and a third of the state’s adult residents now receive Medicaid. Other states, including California, Louisiana, and Oregon, underestimated how many individuals would join, which increased the costs to the federal government significantly. According to Investor’s Business Daily, 24 states that submitted enrollment projections estimated that 5.5 million would enroll, but to date, 11.5 million have enrolled, more than double the projected number. In March 2016, the Congressional Budget Office determined that the 10-year cost projection would require a $136 billion increase.
Kentucky’s Gov. Matt Bevin, who was elected in 2015, said that his state cannot afford Medicaid as it now is. In an effort to save Medicaid, Bevin has submitted a waiver request to the Obama administration. This would change how Medicare works in Kentucky. Premiums ranging from $1 to $37.50 monthly and mandating non-disabled adults to work for coverage would enable the program to continue. According to Bevin, the increased state expense of $1.2 billion will owe to Medicaid during the period of 2017 – 2020 is more than the state can bear, per NPR News.
Although during the campaign, Trump said that he would repeal Obamacare, since the election, his stance has changed to keeping the parts of it that work. Health care reforms that the president-elect and Republicans will likely implement are giving Medicaid block grants to states, per the Washington Post. The grants would not keep pace with rising medical costs and will result in less coverage for those who need it most, such as disabled children and near elderly adults, both of whom require more treatment. Grants would also be cut over a period of time, so fewer individuals would be eligible and payments to providers would also be reduced.
Per the “Healthcare Reform” section of Trump’s website, medical care for undocumented immigrants costs $11 billion annually. His solution is to enforce immigration laws. Many of the individuals here in the U.S. are mothers and children. Children cannot be separated from their parents and if parents don’t receive health care, they won’t be healthy enough to care for their children. The law has not changed which grants American citizenship to children who are born here.
According to Trump, another solution to Medicaid spending is to reduce the number of people who need this public health program by increasing jobs. While it’s true that good jobs provide health insurance, what is unclear is how or when the jobs will be brought back to America. If it is possible, this is a long-term venture and doesn’t provide an answer as to what should be done now.
“To reduce the number of individuals needing access to programs like Medicaid and Children’s Health Insurance Program we will need to install programs that grow the economy and bring capital and jobs back to America. The best social program has always been a job – and taking care of our economy will go a long way towards reducing our dependence on public health programs.”
A halt will be made to Medicaid expansion under Trump, and when block grants are issued states will have to decide the best way to spend limited resources. There will be fewer community health clinics, and there will also be a decrease in providers who are willing to accept the lower amounts that Medicaid will pay. If states change their eligibility criteria, many adults who gained health care coverage during the expansion will lose it.
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