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Medicaid expansion: Still a great deal, especially for cities

So many uninsured people could get covered if Medicaid expansion were universal instead of just here and there.

It's constitutional - deal with it

It’s constitutional – deal with it

Expanding Medicaid under the new health care law would do a lot to slash the number of uninsured people, at least in some of the nation’s largest cities, according to a new report.

A review of 14 diverse big cities finds that the cities in states that are expanding the low-income health care program under the Affordable Care Act will see roughly twice the decline in the number of insured compared to cities in states not opting for the expansion, according to an analysis by the Robert Wood Johnson Foundation and the Urban Institute.

Three states are still debating whether to implement the expansion, while 21 have declined it, according to a count from last week by the Kaiser Family Foundation.

The seven cities in states expanding the program will likely see the number of uninsured drop an average 57 percent, while the remaining seven cities will see an average 30 percent drop, the report finds. The projected declines range from 25 percent in Atlanta, Ga., which isn’t expanding, to 66 percent in Detroit, Mich., which is.

Medicaid expansion would affect large portions of each city reviewed, but it would have an especially huge impact on four of the 14. More than half the population in Detroit, Memphis, Miami and Philadelphia, would be eligible for Medicaid after expansion, but only Detroit is in a state opting for expansion.

Medicaid is just one aspect of the law. Combine its impact with the law’s subsidies, and more than half the population in all but one city would be eligible for some kind of insurance assistance, the report’s authors find. The resulting flow of revenue to the cities would be a boon to their economies, the authors argue.

You can see the report here. The Chron mentions this in passing but doesn’t bother going into any details. Not really surprising that big cities would do disproportionately well under Medicaid expansion, but of course only those cities lucky enough to be in the states that chose the rational and compassionate path will benefit that way, even as the states that have rejected Medicaid expansion could really use it. More here from Think Progress.

Meanwhile, a related story from the Trib, even if it didn’t realize it was related.

The sheriff of the state’s largest county is peeved with the Texas Department of State Health Services, the agency that runs the state’s mental health hospitals.

The agency is not offering the care that it is required to provide, the Harris County sheriff, Adrian Garcia, said. Given proper treatment, the sheriff argues, some patients would not be committing the crimes of which they are accused. Instead, they end up in Harris County’s jails, where they are a health care and financial burden to the county.

Sheriff Garcia has allies, and might even get some help. The state agency is being reviewed by the Legislature’s Sunset Advisory Commission, which will hold hearings later this month on a report from its staff that calls the system a mess. “Resolving the current crisis in the state mental health hospital system requires action, starting now,” the first recommendation states.

The report is remarkably clear, as these things go, detailing changes in organization and programs that would reboot the agency. It has floundered since undergoing a reorganization ordered by lawmakers who were trying to create “a truly integrated health services organization” in 2003.

“The state mental health hospital system is dealing with enormous pressure from increased commitments from the courts, and the review found that a lack of communication and collaboration between DSHS and the judiciary only exacerbates the problem,” the staff analysts wrote. They added that out-of-date facilities, “critical shortages” of clinical staff and the agency’s struggles with organization and new legislative initiatives have added to the troubles. The agency did not offer much resistance in its formal response, saying the report “captures the challenges we face” and that agency officials “understand and support the intent and direction of the recommendations.”

In other words, the system is not working. The recommendations include increasing staff for the hospitals and expanding capacity by contracting with local providers whenever possible.

I say it’s related because jail inmates and people with chronic mental illnesses are two more populations that would greatly benefit from Medicaid expansion, as we’ve discussed before. Wouldn’t it be nice to have the federal government pick up some of this tab, as they are ready and willing to do, unlike the state? Yeah, sorry about that. We’ll need to have a better state government first, then we can see about that.

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