The Affordable Care Act, often referred to as Obamacare, became entrenched in the national safety net after a third U.S. Supreme Court ruling upholding its constitutionality.
As a result of the move, President Joe Biden’s administration and various states are looking to upgrade Medicaid, the federal state program that provides medical coverage to low-income Americans and people with disabilities.
Several states are taking advantage of a $ 1.9 billion American Rescue Plan Act provision signed by Biden in March that allows Medicaid to offer one year of health coverage to new mothers instead of the current 60 days.
While this provision has been overshadowed by other parts of the bailout, it’s a big deal, as Biden might put it.
The United States has a high infant mortality rate for a developed country, 5.7 deaths per 1,000 births. This translates to over 22,000 infants dying each year.
Medicaid covers nearly half of all births in the United States, and experts say improved newborn care will save lives.
Medicaid is growing at a rapid rate
Overall, Medicaid, known as Medi-Cal in California, now insures nearly one in four Americans and is growing faster than any US safety net program.
Enrollment in Medicaid and the associated children’s health insurance program fell from 71.3 million in February 2020, at the start of the COVID-19 pandemic, to 80.5 million in January of this year, according to an analysis of data from the Kaiser Family Foundation.
“The pandemic has forced states to review their programs, and efforts have been made to improve access,” said Emily Blanford, Medicaid specialist at the National Conference of State Legislatures.
A helpful ARPA provision will provide $ 12 billion for long-term Medicaid services. This will enable millions of older people to receive health services at home and in their communities, rather than in nursing homes and other institutions.
Forty-two states have requested funding under this program.
ARPA also provides additional Medicaid funds to states to establish mobile crisis services for people facing mental health or substance abuse emergencies.
“There was a lot of talk (about this) during (President Donald’s) Trump administration, but not the capital to do it,” Kate McEvoy, Connecticut’s Medicaid program director, told KFF.
On another front, California has budgeted $ 1.3 billion to extend health insurance to unauthorized immigrants aged 50 and over. The state estimates that this will cover 175,000 adults in 2022.
Since 2016, the Golden State has provided health insurance for children of unauthorized immigrants up to the age of 18.
Five other states – Illinois, Massachusetts, New York, Oregon and Washington – and the District of Columbia offer health insurance for children up to 18 years of age. Sixteen states provide antenatal care to undocumented pregnant women.
Courts reject Republican ACA challenges
All of these states have Democratic-controlled legislatures and – with the notable exception of Republican Governor Charlie Baker in Massachusetts – Democratic governors.
It’s not surprising. ARPA was passed by Congressional Democrats in a party line vote, as was the Affordable Care Act, enacted in 2010 by President Barack Obama.
But the talks to buy health insurance didn’t start until 2014, and Republicans effectively opposed Obamacare in the gap between the law’s passage and the creation of the exchanges.
Demonizing Obamacare as a step towards socialized medicine, Republicans seized control of Congress and the majority of state legislatures in the 2010 midterm elections.
But Republicans have done badly since the ACA took full effect in 2014; The GOP’s efforts to overthrow Obamacare have failed three times in Congress and three times in the Supreme Court.
The High Court’s acceptance of Obamacare gradually widened: 5-4 in 2012, 6-3 in 2015, and 7-2 in June of this year, when even Judge Clarence Thomas, the most conservative judge of the court, joined the ratification of the ACA.
In the latest challenge, attorneys general for Texas and 17 other Republican states claimed the law became unconstitutional when Congress in 2017 eliminated the financial penalty for Americans who did not purchase health insurance.
The majority of the court ignored this argument, ruling that the states which had brought the lawsuit had no standing because they had not been wronged by the ACA.
ACA is growing in popularity
As a result of the court ruling, most Republicans have abandoned the effort to kill the Affordable Care Act. Republican congressional leaders criticized the decision but did not repeat previous calls to repeal and replace Obamacare.
This may reflect the growing popularity of the law. A May poll by the Kaiser Family Foundation found that respondents were in favor of ACA by a range of 53% to 35%.
The ACA has three goals: to make health insurance affordable for more people, to expand Medicaid, and to support the research and development of innovative medical care that could lower overall health care costs in the United States.
He partially managed the first two goals, while the third was largely delayed by COVID-19.
As of June 15, 31 million Americans had obtained ACA health care coverage, according to the Department of Health and Human Services.
HHS data identified 11.3 million Americans as having obtained coverage through exchanges and 14.8 million enrolled in Medicaid due to the expansion of ACA eligibility.
Thirty-eight states and the District of Columbia have extended Medicaid to provide health insurance to families and individuals with incomes up to 138% above the poverty line. (The federal poverty line is $ 12,880 for an individual and $ 31,040 for a family of five.)
Single adults were covered in the expansion for the first time.
Twelve Republican-controlled states, including Florida and Texas, have refused to extend Medicaid to ACA levels despite generous federal grants if they do so. This has left an estimated 2 million people in these states without health insurance.
Medicaid and Obamacare still face an uncertain future
Looking ahead, Medicaid and Obamacare face uncertainties as the nation emerges from the coronavirus pandemic into a changing healthcare landscape.
Medicaid was created in 1965 by the same law that, at the behest of President Lyndon B. Johnson, created Medicare, the federal medicare program for the country’s seniors.
Unlike Medicare, however, Medicaid was voluntary for the states, which shared the costs of the program. Arizona, the last state to do so, only implemented a Medicaid program in 1982.
Forty-three states cut Medicaid benefits during the Great Recession from December 2007 to June 2009, placing heavy burdens on state and local governments.
When the pandemic hit in 2020, state budget analysts feared a repeat of the Great Recession scenario, but federal financial payments to individuals and extended unemployment benefits kept Medicaid growth lower than expected.
Congress has also helped by increasing the federal share of Medicaid costs.
Nonetheless, total Medicaid costs to states exceed $ 600 billion, and states may have to cut benefits during the next economic downturn.
When it comes to the Affordable Care Act, current upgrades may prove to be even more fleeting.
Even the cheapest insurance plans available on the ACA were beyond the financial reach of millions of Americans who did not qualify for a subsidy.
The Biden administration solved this problem in ARPA by extending eligibility for ACA health insurance subsidies to people with incomes above 400% of the poverty line. But the provision only lasts for two years, retroactive to January 1, 2021.
The Republican perception of the ACA as a partisan agenda remains its Achilles heel.
To maintain the health insurance upgrades made possible by Biden’s election and passage of ARPA, Democrats will need to either persuade some Republicans of their merits or win the 2022 midterm legislative election. .
Achieving either of these goals could prove to be a tall order.
– Lou Cannon, a resident of Summerland, is a longtime national political writer and acclaimed presidential biographer. His most recent book – co-authored with his son, Carl – is Reagan’s Disciple: George W. Bush’s Troubled Quest for Presidential Legacy. Cannon is also an editorial advisor to the State Net Capitol Journal, which originally published this column. Click here to read the previous columns. The opinions expressed are his own.