Eye on the States: Medicaid Expansion

In 2010 President Obama signed the Patient Protection and Affordable Care Act (ACA) into law. This act contained a number of provisions aimed at providing better access to health insurance and ensuring that everyone is able to participate in the healthcare market. One of the key mechanisms for providing healthcare coverage to those with low-incomes is the “Medicaid expansion.”

Medicaid is a program administered by the states and paid for with a match from the federal government; the exact match varies from state to state, but it can be as high as 3 federal dollars to every state dollar. Prior to the Affordable Care Act, the only people eligible for Medicaid had to be low income AND be in one of a number of categories of disabled or special needs individuals; qualifications included, among others, being disabled, pregnant, caring for children under age 18 or suffering from physical ailments like blindness.

In order for states to get Medicaid funding, they had to cover all who can be categorized under seven specific categories but could optionally cover individuals in other categories as well. The ACA added a new, eighth category to cover everyone whose annual income is less than 138% of the federal poverty line regardless of qualifying for any other category. This was significant because, for the first time, a person could be eligible for Medicaid solely based on their income level. Further, because of its placement in the statute it required all states to include coverage for these individuals or all of their Medicaid funding would be in jeopardy. The federal government will cover 100% of the cost for these newly covered recipients for the first three years, and then will taper the funding to 90%. This means at its most costly, states would receive $9 for every $1 they spend.

In June of this year, the Supreme Court ruled that the threat presented by the ACA of eliminating all Medicaid funding constituted “a gun to the head of states” and was therefore unconstitutional. As a matter of practicality, the expansion has now been rendered optional.

Right now states are deciding whether or not to expand their Medicaid programs. The expansions, or lack thereof, could have profound implications for low-income individuals across the country. Furthermore, states have the opportunity to actually gain financially from the federal government by expanding coverage. As such it is important for the Jewish community to continue to pressure our respective states, emphasizing the importance of the expansion for each of our communities.

We learn from ancient Jewish scholars and texts that providing health care is not just an obligation for the patient and the doctor, but for the society as well. It is for this reason that Maimonides lists health care among the ten most important communal services that had to be offered by a city to its residents. (Mishneh Torah, SeferHamadda IV:23). During the long history of the self-governing Jewish community, almost all such communities set up societies to ensure that all their citizens had access to health care. Doctors were required to reduce their rates for poor patients and, where that was not sufficient, communal subsidies were established (Shulchan Aruch, Yoreh Deah 249:16; Responsa Ramat Rahel of Rabbi Eliezer Waldernberg 24-25).

So far Arkansas, California, Connecticut, Delaware, Washing D.C., Hawaii, Illinois, Maryland, Massachusetts, Minnesota, Rhode Island, Vermont and Washington have declared their intentions to implement the expansion. This week Oklahoma joined Florida, Georgia, Louisiana, Mississippi, South Carolina and Texasin rejecting the expansion. The remaining states have not yet made their intentions clear.

Those states that ultimately choose not to participate in Medicaid expansion place the lives of the most vulnerable in their communities at risk. We must not let this stand.

Check back at RACblog as we continue to follow the effects of the Affordable Care Act.