If you thought the Supreme Court ruling that upheld Obamacare was good news, you were right...partially
When SCOTUS gave its "thumbs-up" to ACA it affirmed numerous positive benefits for women, including the elimination of gender ratings - insurance companies' practice of charging women more for premiums than men, annual wellness exams and screenings without copays, eliminating lifetime and annual caps on coverage, prenatal care and coverage, and coverage for reproductive care, including contraception, among others.
But the Court also altered Obamacare in a very fundamental way: it limited expansion of Medicaid to voluntary participation rather than the mandatory expansion ACA originally called for.
Medicaid expansion, along with state health insurance exchanges, is the linchpin of President Obama’s plan to provide insurance coverage to 30 million low-income uninsured Americans.
Under existing Medicaid rules low-income non-elderly individuals who don’t have children, or those who aren’t disabled or elderly, aren’t eligible for Medicaid. ACA changed this by including in its mandatory expansion all adults with incomes below 138% of the federal poverty level—$15,415 for an individual; $26,344 for a family of three. By establishing a standard eligibility floor, adults without children who don’t currently qualify for coverage and who can’t afford private insurance, will now be able to obtain insurance coverage via their state’s Medicaid program. In return for states expanding their Medicaid program, the federal would pay close to 100 percent of the costs to insure these newly-eligible individuals starting in 2014.
Here’s the hitch, thanks to the Supreme Court’s ruling: states can now refuse to expand their Medicaid coverage, which will impact millions of low-income women (and men) in states that refuse.
This has real implications for low-income women
Two-thirds of these women (6.6 million) are in their prime reproductive years (19-44). In states that refuse to expand Medicaid these women won’t have insurance coverage and thus no access to critical reproductive or prenatal care: Services like annual breast and cervical cancer screenings, Pap tests, birth control and other family planning services, prenatal care, gestational diabetes screenings, or annual wellness exams, for example.
Given the financial and other costs to states caring for uninsured, the estimated 2.8% increase they would incur in their budgets to expand Medicaid is a small price to pay. Women, especially, gain with insurance coverage, in important ways. When reproductive care (including access to contraception and abortion) is denied or limited, unplanned pregnancies go up, though denial/limitation of care is not the sole reason for this.
Coincidentally, states now with the highest numbers of uninsured are also among those with the highest rates of unintended pregnancies and they are also among those where governors have already declined to expand Medicaid or are strongly leaning toward declining.
Expanded Medicaid and older women
While much of the focus recently in health care reform has been on the health and financial impact to women in their childbearing years – in large part because of sustained attacks and limitations on reproductive rights in many states – the fact is that millions more low-income women will be hurt in states that refuse to expand their Medicaid programs.
One group of women, especially, is uniquely vulnerable.
Known as “low income near elderly women”, these 55-65 year-olds account for 3.7 million of the uninsured nationally.
These women aren’t yet eligible for Medicare. They lack insurance coverage, in part due to the same reasons as younger women: they work in low-wage jobs without insurance benefits, are underemployed, or unemployed, and until passage of Obamacare weren’t eligible for Medicaid.
But there are other age-specific concerns and challenges these women face:
- If they are unemployed, they are less likely than younger women to find employment due to age discrimination, which makes it even more difficult for them to afford private insurance;
- Their lack of health coverage is frequently the result of factors that include losing coverage due to spousal death, disability or unemployment;
- Older women may also lack insurance coverage due to an elder spouse’s eligibility for Medicare, which leaves them frequently unable to obtain private health insurance due to preexisting conditions and illnesses and/or due to prohibitive cost.
Older women also face unique health challenges not experienced by younger women.
“They're in menopause, they have a higher likelihood of pre-existing conditions, they're at a heightened risk for all types of cancers, they're becoming more frail and less mobile, and they don't get preventive care. So, they tend to get sicker and more expensive to deal with when they do finally make it into Medicare."
Under expanded Medicaid provisions, approximately 1.2 million of these women are now eligible for coverage. But once again, in states that don’t expand their Medicaid coverage these women will pay a steep price.
Keep your damned Medicaid off my state
States that have said they won’t voluntarily expand Medicaid are among those with already high numbers of uninsured. Florida and Texas, for example, have roughly 3 million people who are now eligible under expanded Medicaid provisions, according to Kaiser Family Foundation. But, according to Texas governor, Rick Perry:
“To expand this program is not unlike adding a thousand people to the Titanic.”
Perry shouldn’t do metaphors or analogies because he’s, well, a metaphor gaffe machine. People lost their lives on Titanic because there weren’t enough lifeboats for those already on the ship. But, okay, let’s stick with his metaphor for now: The “ship” (in this case, Texas), already has 1.7 million people without insurance (these would be the ones drowning if they were aboard Titanic). Expanded Medicaid coverage is like adding additional lifeboats. More lifeboats equal fewer people drowning.
Meanwhile in Florida, a few Southern states to the east of Texas, there are 1.3 million uninsured now eligible for Medicaid coverage thanks to Obamacare. Sorry, I don’t have a snappy Gov. Rick Scott metaphor to include, but Scott did create a humongous $19 billion fish story about how much it would cost the Sunshine State to expand Medicaid.
At the moment, governors in five other states have also said, “Thanks, but no thanks” to expanded Medicaid: Iowa, Louisiana, Mississippi, Nebraska, and South Carolina.
Between these five states there are over 1 million people who are now eligible for Medicaid. And over 700,000 of them are women who will be left without insurance, thanks to their governors. Clearly, these governors are more concerned with maintaining rigid ideology than doing what’s best for their residents. And of course, 34 other states are still uncommitted, holding off until after the election. GOP governors in these states are no doubt hoping (praying, probably) that Mitt Romney will win the presidency and “get rid of” Obamacare, along with Planned Parenthood and who knows what else.
As we all know, elections have consequences, so if you need a little motivation to vote this year (and a cool graphic talking point to convince others to vote), here you go: