Low-income people in states that haven’t expanded Medicaid are much more likely to forgo needed medical care than the poor in other states, according to a new government report. The nonpartisan Government Accountability Office worked with the National Center for Health Statistics to analyze federal survey data from 2016.
The research focused on low-income adults ages 19-64 in states that did not expand Medicaid under the Obama-era Affordable Care Act, compared to their peers in states that did, including Iowa. Under the law, states may expand Medicaid for low-income people making up to roughly $16,750 for an individual or $34,640 for a family of four. Seventeen states have not adopted the expansion. President Donald Trump’s administration is strongly opposed to Medicaid expansion and tried unsuccessfully to repeal it in 2017.
Among the report’s findings:
—Nearly 20 percent of low-income people in states that did not expand Medicaid said they passed up needed medical care in the past 12 months because they couldn’t afford it. That compared to 9.4 percent in states that expanded the program.
—About 8 percent of those in states that did not expand Medicaid reported they either skipped medication doses to save money or took less medication than prescribed. That compared to about 5 percent in states that expanded. For people with chronic conditions such as high blood pressure, diabetes and asthma, staying on a medication schedule is considered essential.
—About 22 percent of those in states not expanding Medicaid said they needed but could not afford dental care, as compared to 15 percent of similar low-income adults in expansion states.
—About 11 percent of those in non-expansion states said they needed to see a specialist but weren’t able to afford it, as compared to about 6 percent of those in expansion states.
With the federal government covering at least 90 percent of the cost, expansion proponents argue states turning it down are leaving on the table tax dollars their own citizens send to Washington. Backers include hospital systems and health insurers as well as many business groups. Opponents contend that the cost is still too high for states, which have other major financial responsibilities for education, infrastructure and law enforcement, and must balance their budgets.
Medicare and Medicaid administrator Seema Verma has aruged that Medicaid was originally intended as a safety-net program for the most vulnerable in society and covering able-bodied adults is beyond its scope. Verma is encouraging states to set work requirements for Medicaid, contending it will encourage people to earn their way out of poverty and dependence on government insurance.