Has Obamacare Improved Medicaid? - DEBATED


General Reference (not clearly pro or con)
Chima D. Ndumele, PhD, Assistant Professor of Public Health at Yale School of Public Health, Vincent Mor, PhD, Professor of Health Services, Policy & Practice at Brown University School of Public Health, and Susan Allen, PhD, Assistant Program Director of the Advanced Academic Programs Communication Department at Johns Hopkins University, et al., stated the following in their June 2014 study "Effect of Expansions in State Medicaid Eligibility on Access to Care and the Use of Emergency Department Services for Adult Enrollees," published in JAMA Internal Medicine:

"We found no evidence that expanding the number of individuals eligible for Medicaid coverage erodes perceived access to care or increases the use of ED services among adult Medicaid enrollees. States that expand Medicaid are unlikely to observe substantial increases in costs attributable to poor access to care among previously enrolled adults."


The Rand Corporation stated the following in its 2013 research brief written by Carter C. Price, PhD, and Christine Eibner, PhD, "The Math of State Medicaid Expansion," available at rand.org:

"Under the ACA, the federal government will pay 100 percent of the coverage costs for those newly insured under Medicaid expansion. After 2016, the federal share gradually shrinks to 90 percent, substantially more than the 57 percent they currently pay on average...

Medicaid expansion makes health care more accessible to the poorest segment of the population — those earning less than 138 percent of the federal poverty level (this amounts to an income of about $16,000 for a single person or $32,000 for a family of four in 2013)...

Providing insurance to the very poor reduces uncompensated costs of treatment for this group — an estimated $80 billion in 2016. Currently, about one-third of these expenditures come from state coffers."


The Henry J Kaiser Family Foundation, in an Apr. 17, 2015 article written by Kaiser Foundation Senior Researcher Rachel Garfield, et al., titled "The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid – An Update," available at kff.org, stated:

"One of the major coverage provisions of the 2010 Affordable Care Act (ACA) is the expansion of Medicaid eligibility to nearly all low-income individuals with incomes at or below 138 percent of poverty ($27,724 for a family of three). This expansion fills in historical gaps in Medicaid eligibility for adults and was envisioned as the vehicle for extending insurance coverage to low-income individuals, with premium tax credits for Marketplace coverage serving as the vehicle for covering people with moderate incomes. While the Medicaid expansion was intended to be national, the June 2012 Supreme Court ruling essentially made it optional for states.

As of March 2015, 22 states were not expanding their programs. Medicaid eligibility for adults in states not expanding their programs is quite limited: the median income limit for parents in 2015 is just 44% of poverty, or an annual income of $8,840 a year for a family of three, and in nearly all states not expanding, childless adults will remain ineligible. Further, because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults will fall into a 'coverage gap' of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits."




PRO (yes)

Kathleen Sebelius, MPA, former Secretary of the US Department of Health and Human Services, stated the following in her 2014 report to Congress, "HHS Secretary's Efforts to Improve the Quality of Health Care for Adults Enrolled in Medicaid," available at medicaid.gov:

"The Patient Protection and Affordable Care Act (Affordable Care Act), enacted in March 2010, created numerous opportunities to improve the quality of health care for adults enrolled in Medicaid...

Through these new quality-focused activities, states and HHS have unique opportunities to better measure, monitor, and improve health care quality for adults...

CMS is also undertaking large-scale Medicaid-specific prevention initiatives that involve public–private partnerships to pursue the National Prevention Strategy. In 2013, it launched several new activities to support states' efforts to expand access to and improve the quality of preventive health care in Medicaid...

HHS is working to improve the quality of health care for adults in Medicaid with acute and chronic care conditions through a variety of activities, including guidance to states on reducing readmissions and demonstrations designed to test improvements in care for adults who are dually enrolled in Medicaid and Medicare...

A significant segment of the Medicaid population has high needs and high costs. Working with its state partners, CMS has developed several initiatives to improve the availability, affordability, and quality of services for high-need, high-cost Medicaid populations."




Julia Paradise, MS, Associate Director of the Kaiser Commission on Medicaid, stated the following in her Mar. 9, 2015 issue brief "Medicaid Moving Forward," available at kff.org:

"Beyond expanding Medicaid, the ACA introduced other reforms that improve the program in all states, regardless of their Medicaid expansion decision. The law required states to simplify and modernize their enrollment processes, and to create a coordinated eligibility and enrollment system for Medicaid, the Children's Health Insurance Program (CHIP), and the Marketplace, to facilitate enrollment and promote continuity of coverage. The ACA also established an array of new authorities and funding opportunities for delivery system and payment reform initiatives in Medicare, Medicaid, and CHIP, designed to advance better and more cost-effective models of care, particularly for those with high needs and costs, whose care is poorly coordinated, leading to both serious gaps and costly redundancy. Finally, the law provided new options and incentives to help states rebalance their Medicaid long-term care programs in favor of community-based services and supports rather than institutional care. Collectively, these provisions have accelerated Medicaid innovation already underway in many states...

The ACA includes many investments, funding opportunities, demonstration programs, and new authorities designed to drive health care delivery and payment system reforms in Medicaid and other public insurance programs. These provisions have accelerated ongoing innovation in Medicaid programs, including implementation of models like patient-centered medical homes and accountable care organizations (ACOs) that involve a more central role for preventive and primary care, increased care coordination for beneficiaries with complex needs, and financial incentives linked to performance. States are combining and integrating these approaches in different ways with their underlying delivery and payment systems in Medicaid. The ACA also provides states with expanded options and enhanced federal financing to improve access to and delivery of Medicaid long-term services and supports."




Mitchell H. Katz, MD, stated the following in a June 2014 editorial "Health Insurance Is Not Health Care," published in JAMA Internal Medicine:

"In [Medicaid] expansion states, the percentage of Medicaid recipients who reported poor access to care declined from 8.5% prior to the expansion to 7.3% after the expansion. For Medicaid recipients in states where there was no expansion, the percentage remained constant at 5.3%. There was also no differences between expansion and control states in terms of increase or decrease of emergency department use. It did not appear that adding new enrollees worsened the access of those persons who were already enrolled in the program...

To improve access for Medicaid patients, the ACA included a provision that requires that Medicaid reimburse primary care providers at Medicare rates during 2013 and 2014."




The US Council of Economic Advisors (CEA) stated the following in its July 2014 report "Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid," available at the White House website:

"The Affordable Care Act has expanded high-quality, affordable health insurance coverage to millions of Americans...

Medicaid coverage increased the probability that individuals reported receiving all needed medical care over the prior 12 months by 11.4 percentage points...

Medicaid coverage dramatically increased receipt of several important types of recommended preventive care that have been clinically demonstrated to improve health outcomes...

Medicaid also seeks to improve enrollees' health. The findings above showing that Medicaid increases receipt of recommended medical care—care for which there is a strong clinical evidence base demonstrating its effectiveness in improving health—justifies a strong presumption that Medicaid does indeed improve enrollees' health."




CON (no)

Jeffrey A. Singer, MD, practicing surgeon and Adjunct Scholar at the CATO Institute, stated the following in his Oct. 30, 2014 article "Obamacare's Medicaid Expansion Limits Medical Choices," available at cato.org:

"According to a recent study, perhaps up to 80% of ObamaCare's new Medicaid enrollees previously had private insurance plans.

These people are being shunted into a health care program that is substandard to private market alternatives.

Fewer physicians are accepting new Medicaid patients than ever.

Five years ago, 55% of physicians reported accepting new Medicaid patients; today, that number has dropped to 45%...

As illustrated above, this lack of doctors leads to increased wait times for medical care, which ultimately leads to worse health outcomes for these patients.

One recent study found that Medicaid is not only worse than private insurance — it can be worse than having no insurance at all. Medicaid patients were 25% likelier to have an in-hospital death than those completely without health insurance.

The same study also found that, compared with private insurance, Medicaid patients were twice as likely to have an in-hospital death, had the longest lengths of hospital stays and had the highest costs.

Other studies have reached similar conclusions. Two studies from the University of Pennsylvania and Johns Hopkins University found that Medicaid patients have higher mortality rates and higher death rates than patients with private health insurance.

These are startling results for a government-run health care system advertised as a quality substitute for private insurance. In reality, ObamaCare has created a two-tier health care system — and it's forcing millions of patients out of the top tier and into the bottom."




Nina Owcharenko, Director of the Center for Health Policy Studies at the Heritage Foundation, stated the following in her Nov. 19, 2014 article "Poor Americans Deserve a More Compassionate Health Care Solution than Current Medicaid," avaialble at the Daily Signal website:

"The Affordable Care Act allows states to add another category to Medicaid: able-bodied adults, many of whom are without children. The ACA also provides much higher federal funding–as compared to the funding for traditional groups (like moms and kids and the disabled)–to entice the states to expand their program to these able-bodied adults...

But these short-term coverage gains will soon be overshadowed by the longer-term challenges that continue to plague the program and are likely to be exacerbated by the ACA...

There have been numerous academic studies that have exposed the fact that Medicaid patients have worse access and outcomes than privately insured patients. For example, a 2003 study found that health outcomes for colorectal, lung, prostate and breast cancer in Kentucky were higher for privately insured than those on Medicaid. A 2010 study found similar results for non-cancer-related illnesses...

Medicaid needs reform, not expansion. Medicaid has its place in providing a safety net. But, it should be a secure safety net, not one filled with holes and patches. Policymakers and advocates for the poor should also begin to think about better ways to serve the poor."




The US Senate Republican Policy Committee stated the following in its Feb. 10, 2015 article "Obamacare Expanded Medicaid, Not Private Insurance," available at its website:

"In 2014, nearly all of Obamacare's net effect on insurance coverage resulted from increases in the failing Medicaid program. This happened even though only about half of states chose to expand their Medicaid programs under the law...

One of Obamacare's most perverse features is that the federal government now reimburses states substantially more for providing Medicaid services to able-bodied, working-age adults than for the disabled and for low-income children, pregnant women, and seniors. These were the people traditionally covered by Medicaid. This funding mechanism could lead states to provide generous services to some people, while skimping on care for the truly needy.

Medicaid suffered from serious problems prior to Obamacare's enactment. These included: escalating spending increases; low provider participation; poor quality of care; large crowd-out of private sector coverage; and perverse incentives that discouraged working and saving. The program needed major reform, not a blanket expansion...

Americans enrolled in Medicaid have less access to health care. When they do receive care, the quality is often inferior."




Hadley Heath Manning, Health Policy Director at the Independent Women's Forum, stated the following in her Dec. 15, 2014 article "Medicaid Wrapped in an Obamacare Bow," available at usnews.com:

"In the first two quarters of 2014, 6.1 million people were added to the Medicaid program. Another net 2.5 million people enrolled in private health insurance during that time, but the new plans available in the Obamacare exchanges – while technically private – look and function more like Medicaid plans with limited networks, low physician reimbursement, and high public costs...

Obamacare has added enormously to public health spending, and as a result, more people have lower-quality health plans...

Instead of changing the private market to look more like a substandard government program, we should have gone in the opposite direction, encouraging reforms to Medicaid and our entire health care system to foster greater competition and choice, so that everyone has the opportunity to buy quality, affordable, reliable health coverage."