Problem Statement
This discussion will cover the issue of the Medicaid expansion gap, a health policy concern of states that have chosen not to implement the Medicaid provision expansion plan under the Affordable Care Act (ACA) (Collins & Saylor, 2018). This decision produces millions of poor citizens without reasonable health insurance packages, and this prompts injustice with regard to healthcare access across state lines in the United States of America. As a result, most people below the poverty line fall into a coverage gap because they cannot qualify for Medicaid and are not qualified to get subsidies that enable them to buy coverage through the ACA Marketplace (Collins & Saylor, 2018). Apart from this, such unevenness in the provision of health care deepens inequity more so among disadvantaged groups such as the indigenous people, the working poor, and those in rural areas. In addition, limited coverage restricts people’s ability to get the correct medical care. Also, it results in numerous consequences, such as poor health outcomes and increased financial burden for healthcare providers. Lastly, it adds to the more extensive societal health concerns. To solve this challenge, policy interventions can be implemented to close the gap and ensure that everyone in America gains equal access to health care despite their address or
Background Information.
The Medicaid expansion gap is one of the most significant problems in distributing access within the United States. The ACA’s Medicaid expansion was meant to offer services to citizens and families that previously did not fit within the guidelines for the traditional Medicaid eligibility criteria (Gluck et al., 2019). On the other hand, however, the affirmation by the Supreme Court in 2012 made Medicaid expansion voluntary for states, leaving them with a patchwork of coverage in the US. According to Tolbert and Drake (2023), 12 states refused to expand Medicaid, and nearly 2.2 million low-income Americans lack affordable health insurance coverage.
This coverage gap unevenly affected other segments of the population, such as minorities, the working poor, and rural residents (Gluck et al., 2019). Interestingly, among these communities in states that did not expand access to Medicaid, 18% of African American and 10.0% of Hispanic populations do not have insurance, unlike states with expanded access to Medicaid coverage (Tolbert & Drake, 2023). Additionally, people in the coverage chasm have to overcome substantial obstacles to receiving needed medical care, and this can result in poorer health and more financial burden on healthcare providers.
In addition, the discrepancies exposed by the Medicaid expansion gap have been amplified during the COVID-19 pandemic (Allen & Sommers, 2020). According to Allen & Sommers (2020), the uninsured population was undergoing complications in accessing COVID-19 tests, treatments, and vaccinations, risking public health regarding existing health inequalities. The problem continues to grow, and urgent policy response is required to identify and solve the coverage gap as a fundamental cause of Americans’ limited access to healthcare in specific areas and based on income.
Landscape/Stakeholders
The landscape of the Medicaid expansion gap is primarily comprised of various stakeholders, each with unique interests and responsibilities in shaping healthcare policy and design (Assistant Secretary for Public Affairs (ASPA), 2022). First are the patients, primarily low-income individuals and families, who find themselves in the gap between those eligible for Medicaid and those eligible for market-based insurance. These groups of persons face severe challenges in accessing these services because they are not insured. Hence, they tend to delay obtaining the relevant care, which in most cases results in lousy health status (Assistant Secretary for Public Affairs (ASPA), 2022). This is crucial to their health systems, and solving the Medicaid expansion gap enables them to have equal access to medical facilities and good health.
Other vital stakeholders affected by the Medicaid expansion gap are healthcare providers such as doctors, nurses, and hospitals (Collins & Saylor, 2018). Though uninsured patients bear the significant costs of their care, the providers care for them in emergency settings or when complications arise from delayed treatment. Health care systems and resources are under stress leading to dramatic uncompensated care costs and operational struggles (Collins & Saylor, 2018). Closing the coverage gap would help the patients access care from the providers and relieve financial strain, ultimately allowing providers to serve their communities better.
Payers such as private insurance companies and government-sponsored programs such as Medicare are very much out of the expansion of the Medicaid debate (Borgschulte & Vogler, 2020). Medicaid expansion would surely increase the number of covered people and the cost savings for insurers in uncompensated care costs. However, the commitment of the states and the federal government towards it is substantial. According to Borgschulte and Vogler (2020), policymakers are vital in mediating these competing interests and play a critical role in defining the directions of future healthcare policies. Their determinations concerning Medicaid expansion affect millions of Americans’ access to care. However, they are also of broader consequence as they pertain to the delivery and financing of the nation’s healthcare (Bellerose et al., 2022). Advocacy and special interest groups have also contributed to the Medicaid expansion debate by lobbying legislators, organizing grassroots advocates, and conducting public awareness campaigns to attract diverse healthcare stakeholders and the public (Borgschulte & Vogler, 2020). By affecting policymakers and public opinion, their actions influence the direction of healthcare policy and decide the future of the policy reforms that aim at closing the Medicaid expansion gap.
Options to Address the Problem
Covering the Medicaid expansion gap involves carefully examining policy solutions that accommodate expanding affordable healthcare access to people experiencing poverty while working around the intricate political and economic terrain (Bellerose et al., 2022). As a possible policy measure, the federal government can offer incentive funding to states through incentives, which would lead to states expanding Medicaid. Policymakers can achieve participation and help with the coverage gap using the federal funding play as much as possible, aiming to increase the federal funding for states that decide to increase Medicaid coverage. This approach attempts to resolve health problems by extending insurance coverage to millions of poor people who do not receive medical assistance due to the cost of their inability (Offer, 2022). This choice provides several benefits, such as better health outcomes among the vulnerable population, lowered uncompensated care costs to the providers, and support of a better healthcare system. Nonetheless, difficulties may ensue in obtaining political buy-in for more federal spending and persuading non-expansion states to join the game, especially in regions where Medicaid expansion is a politically charged topic.
National-level policy options can include a federal public option or Medicaid buy-in program. Under this option, persons living in other states that did not undergo expansion could acquire Medicaid coverage through a federally run program despite their income level (Offer, 2022). This would open up another option route for those currently lingering on the coverage gap to have affordable medical care. This alternative seeks to deal with the health problem by implementing the present Medicaid structure, which is justifiable by increasing insurance coverage and eliminating the variances in access to care. Besides, this has advantages, including coverage for people in the non-expansion states, competition in the insurance market, and possible reduction of healthcare costs.
Recommendation
From the above analysis, the most promising and effective solution to the Medicaid expansion gap is a combination of policy solutions. Medicaid expansion can be a win-win situation for states like Texas and Florida if they can be incentivized through federal funding incentives. This can spur many states that have not participated yet in Medicaid expansion to do so and give health coverage to millions of low-income people (Offer, 2022). With that said, a federal public option or Medicaid buy-in program could serve as a substitute pathway to coverage for those residing in non-expansion states as well, thus increasing the elimination of disparities in care access. Notably, this can be seen in the expansion of healthcare policy in North Carolina and Dakota, where the two states have received $60 million and $1.2 million, respectively (Moghtaderi et al., 2020).
Nevertheless, the challenge with such measures is to generate a consensus through compromise and negotiation to avoid political and economic feasibility difficulties. According to Offer (2022), stakeholder involvement and communication, along with the focus on potential trade-offs, including the elevated level of federal spending against the superior results of health outcomes and reduced expenditures on uncompensated care, will be vital. Finally, an integrated and participatory solution that couples both policy alternatives in a step-by-step plan can provide the most favorable solution, filling the gap by finely tuning challenges and endeavoring to fulfill the benefit to all parties involved.
References
Allen, H. L., & Sommers, B. D. (2020). Medicaid and COVID-19: at the center of both health and economic crises. Jama, 324(2), 135-136.
Assistant Secretary for Public Affairs (ASPA). (2022, March 16). About the Affordable Care Act. HHS.gov. https://www.hhs.gov/healthcare/about-the-aca/index.html
Bellerose, M., Collin, L., & Daw, J. R. (2022). The ACA Medicaid Expansion And Perinatal Insurance, Health Care Use, And Health Outcomes: A Systematic Review: Systematic review examines the effects of expanding Medicaid on insurance coverage, health care use, and health outcomes during preconception, pregnancy, and postpartum. Health Affairs, 41(1), 60-68.
Borgschulte, M., & Vogler, J. (2020). Did the ACA Medicaid expansion save lives? Journal of Health Economics, 72, 102333.
Collins, B. L., & Saylor, J. (2018). The Affordable Care Act: where are we now? Nursing2022, 48(5), 43-47.
Gluck, A. R., & Scott-Railton, T. (2019). Affordable Care Act Entrenchment. Geo. LJ, 108, 495.
Moghtaderi, A., Pines, J., Zocchi, M., & Black, B. (2020). The effect of Affordable Care Act Medicaid expansion on hospital revenue. Health Economics, 29(12), 1682-1704.
Moghtaderi, A., Pines, J., Zocchi, M., & Black, B. (2020). The effect of Affordable Care Act Medicaid expansion on hospital revenue. Health Economics, 29(12), 1682-1704.
Offer, O. (2022). The Expansion of Medicaid. Journal of Undergraduate Social Work Research, 6(2), 68-81.
Tolbert, J., & Drake, P. (2023, December 18). Key Facts about the Uninsured Population | KFF. KFF. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/
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