The Kaiser Family Foundation policy research on medicaid expansion and the implementation of the current healthcare reform is very optimistic and useful. However, it would be prudent to look at the local healthcare infrastructure’s ability to both create (healthcare outreach) and meet the new demand for the coverage that the healthcare act promises. Indeed, a decade of the most draconian recession in recent history has not helped the public health sector to recruit and diversify its workforce in order to be ready to take on the potential numbers of Latinos, for example, who would benefit disproportionately from the new access as they are over represented in the labor and business sectors that currently provide jobs without health benefits. According to the Kaiser Family Foundation, the healthcare reform picture is quite rosy, but for Latinos healthcare reform may not be quite the rose garden envisioned by current mainstream health policy pundits. The Policy ThinkShop
According to the Kaiser Foundation:
“A central goal of the Patient Protection and Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and new Health Insurance Exchanges. Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. These decisions will have substantial consequences for health coverage for the low-income population. The 3 key questions that states should consider in evaluating the ACA Medicaid expansion are:
1. What are the fiscal implications of the ACA Medicaid expansion for states?
Overall, many states are likely to see net savings from the Medicaid expansion.
The Medicaid expansion also may have positive economic effects for states like increased jobs, revenues or economic activity.
Studies show that the Medicaid expansion could increase revenues to hospitals, offsetting hospital reimbursement reductions that were also included in the ACA.
Some states are concerned about federal deficit reduction efforts and the implications for Medicaid; however, the FMAP formula that determines the federal share of Medicaid spending has remained steady since the start of the program. Congress has only amended the formula to provide more federal funding, not less.
2. What effect will the Medicaid expansion have on coverage?
The Medicaid expansion would make health care coverage available to millions of low-income adults and significantly reduce the number of uninsured.
A large body of research shows that Medicaid increases access to care and limits out-of-pocket burdens for low-income people. Despite claims to the contrary, research points to improved outcomes and reduced mortality from Medicaid coverage.
Actions to address workforce challenges and low provider participation in Medicaid will be important to improve access with the Medicaid expansion.
For most states that do not implement the ACA Medicaid expansion, there will be large gaps in coverage for low-income individuals because individuals with incomes below poverty are not able to access subsidies to purchase coverage in in the new health insurance exchanges.
3. What flexibilities do states have in implementing the Medicaid expansion?
States have considerable flexibility to administer traditional Medicaid programs.
Under the ACA Medicaid expansion, states have flexibility around benefits, cost sharing as well as how to deliver and pay for care.
Proposals are emerging that would allow states to purchase exchange coverage for Medicaid expansion enrollees through premium assistance options.
States also continue to have ability to seek approval for demonstration waivers. Beginning in 2017, 1115 waivers may be combined with State Innovation Waivers.”