Healthcare Reform - What We Learn From Medicaid

Jan 26, 2023

Good Day Healthcare Advocates

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Mission

The Healthcare delivery system in the United States is a patchwork that leaves much to be desired. It is the most expensive system among the top 35 industrial countries and covers far fewer participants delivering lower levels of quality care than many of our peer nations. This blog will provide:

Current problems in healthcare
Actions you can take
References

Current Problem - Medicaid Has Issues

Teammates - we are in an unusual situation. Medicaid is a federal program that helps provide health insurance coverage to the very poor. Typically, you and your family need to be at or near the poverty line. That’s about $ 27,494 yearly income for a family of 4 with 2 children. Pretty meager. The federal government provides funds to the States for their Medicaid programs, because each state can decide how they want to administer it (that’s a danger in itself). The states augment the federal monies and we’re off to the races. The Affordable Care Act offered to increase funding for states that chose to expand Medicaid to those whose income was up to 138% of of the federal poverty limit. Most of the additional funding would come from the federal government. 39 states chose to do so. The rest, not so much.

Not so fun fact 1: 27% of the people in the US are on Medicaid. That’s about 89 million who can’t afford health insurance. We don’t just have a healthcare crisis we have a poverty crisis.

Not so fun fact 2: Medicaid expansion cuts maternal mortality by 7 deaths/100,000 live births (link). Remember we discussed this a few days ago. Maternal mortality is death due to pregnancy complications and death up to 1 year post-partum. Most of our industrialized peer nations are in the 1.7 deaths to 8.7 deaths / 100,000 live births and we are over 17 (link). Black, Native American women are super high, some years as high a between 50 and 35 deaths/100,000 live births. Medicaid expansion allows women to be seen by doctors and the result is that there are 7 fewer deaths/100,000 in Medicaid expansion states.

What did Medicaid expansion do? According to the Center on Budget and Policy Priorities.

More access to care for preventive, immediate, and chronic conditions. There was also increased access to addiction treatment and for behavioral health issues.

Fewer premature deaths in adults because they were able to see a doctor. As of 2020 it was at least 19,000 lives saved. One of the key quality measures of a health care system is how many lives are lost when they could have been treated and saved (deaths amenable with treatment). This is a significant improvement.

If you’re a provider, there was a 55% drop in uncompensated services. One of the things that keeps healthcare costs high.

So overall, Medicaid expansion is good, lives are saved, but not good enough. Each state determines what is covered and what isn’t. There is a heartbreaking story about a young woman with Lupus in T. R. Reid’s book, “The Healing of America” She had a job and healthcare until her Lupus forced her out of work. She was living in a state where her Medicaid plan did not cover her essential long term prescription because the state legislature chose not to carry it in the Medicaid formulary. It was more than she could afford on her own. Without the medication she suffered multiple organ failures, costing many millions of dollars in the ER and she eventually dies at about age 30. Had she had the medicine she would have been productive, back at work and paying taxes at far lower cost than was expended by this kind of legislative torture.

We need a workable healthcare plan for all of us, not some for all of us. Let people know. It has to cover the other 8% that have NO healthcare because they deserve a life as well.

What You Can Do - Contact the Whitehouse

Text SIGN PCFKFT to 50409 to send the letter below to President or cut and paste the text into this link

President Biden, We have a healthcare crisis. 27% of the population is on Medicaid. 8% of the population has no health insurance. States with expanded Medicaid have lower maternal mortality than states who did not expand Medicaid. That’s good. But that leaves women at higher risk in the non-expansion states and even worse the individual state legislatures determine what procedures and medicines they will cover, often leaving disaster in their wake when a needed prescription cannot be had because it is not on the state’s formulary. Remember our country allows 8% of the population (24M) to have no insurance and they are at worse health and financial risk than ever. You can do something. Please authorize an executive committee to determine how to implement universal healthcare in the US. All of our peer industrialized nations have it and they provide higher quality care for everyone at far lower cost. We all deserve healthcare. You can do this and we are counting on you.