Medicaid is a vital program for the healthcare coverage for low-income individuals, pregnant women, children, and people with disabilities. It was first established in 1965 (LaPelusa & Bohlen, 2023). Over the years, Medicaid has been expanded to cover a broad spectrum of medical services and has played a pivotal role of improving health outcomes for millions of Americans. As of May 2023, there were 86,783,676 individuals enrolled in Medicaid (“May 2023 Medicaid & Chip Enrollment Data Highlights”, 2023). Some programs offered in Medicaid include the Medicaid Home Health program and the Medicaid Managed Long-Term Services and Supports program (LaPelusa & Bohlen, 2023). Coverage was further expanded during the Covid-19 pandemic, providing benefits to many people in need. The recent rollback in Medicaid coverage have raised concerns about the health and financial stability of those dependent on this program.
Medicaid operates as a joint federal-state program, meaning states have flexibility in determining coverage and eligibility criteria for Medicaid recipients (LaPelusa & Bohlen, 2023). In 2015, the Affordable Care Act was enacted, leading to a substantial surge in Medicaid enrollment. The Center for Medicare and Medicaid reported that Medicaid enrollment grew by 16.4 million between 2013 and 2016 (Mazurenko, 2018). This expansion was adopted by 31 states and Washington D.C. (Mazurenko, 2018). In the states with Medicaid expansion, adults with incomes below 138% of the federal poverty level are eligible for enrollment (Seiber & Berman, 2017). Though the expansion of Medicaid was meant to be enacted across the country, the US Supreme Court ruled in 2012 that states could choose not to expand Medicaid coverage (“May 2023 Medicaid & Chip Enrollment Data Highlights”, 2023). Once the Affordable Care Act’s maintenance-of-effort requirements expired after 2019, states were permitted to reduce Medicaid eligibility to minimum thresholds allowed by federal law (LaPelusa & Bohlen, 2023).
The rollback of Medicaid coverage has significant consequences for the health and financial stability of individuals. Increasing health insurance coverage is associated with improved health outcomes. The Medicaid expansion following the passage of the ACA has led to improvements in healthcare access and quality and decreased healthcare spending (Mazurenko, 2018). While there are conflicting results regarding whether Medicaid expansion increased or decreased hospitalization rates, there appears to be a reduction in emergency department visits among people who are uninsured (Mazurenko et al., 2018). Additionally, there seems to be improvement in appointment availability and wait times after Medicaid expansion (Mazurenko et al., 2018). However, some studies have found increased wait times with the expansion. This could be due a surge in patient load (Mazurenko et al., 2018). Medicaid expansion is also associated with increased rates of cancer screening and monitoring of chronic health conditions such as diabetes. It has generally been associated with various improvements in people’s health (Mazurenko et al., 2018).
In conclusion, the rollback of Medicaid coverage is a pressing issue in American healthcare with profound implications for low-income individuals and vulnerable populations. The fate of the ACA is unclear as to whether it will be repealed or substantially altered (Seiber & Berman, 2017). It is crucial for policymakers to collaborate on proactive and comprehensive solutions. Furthermore, future research should continue to assess trends in healthcare outcomes and spendings in states that have Medicaid expansion and those without it.
References
- LaPelusa, Andrew, and Julie Bohlen. “Medicare, Medicaid, and Military and VA Healthcare Programs .” StatPearls, National Library of Medicine, 16 July 2023, www.ncbi.nlm.nih.gov/books/NBK594241/.
- “May 2023 Medicaid & Chip Enrollment Data Highlights.” Medicaid, Centers for Medicare & Medicaid Services, 28 Apr. 2023, www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html.
- Mazurenko, Olena et al. “The Effects Of Medicaid Expansion Under The ACA: A Systematic Review.” Health affairs (Project Hope) vol. 37,6 (2018): 944-950. doi:10.1377/hlthaff.2017.1491
- Seiber, Eric E, and Micah L Berman. “Medicaid Expansion and ACA Repeal: Evidence From Ohio.” American journal of public health vol. 107,6 (2017): 889-892. doi:10.2105/AJPH.2017.303722
