(image by courtesy of Sam Dickman)
My guest today is Harvard Medical School researcher and third year medical student, Samuel L. Dickman. Welcome to OpEdNews, Sam.
SD: Thank you, Joan.
JB: You were involved in a study by researchers at Harvard Medical School and the City University of New York [CUNY] which was just released. What can you tell us about it?
SD: We wanted to look at the health and financial impacts of persistently high uninsurance in the US. Most people know that the Affordable Care Act of 2010 -- also known as ObamaCare -- was designed to decrease the number of uninsured, and it was going to do that in two ways: first, by setting up insurance "exchanges" where people could comparison shop for private health plans and get subsidies to help pay the premiums (as long as their incomes were within a certain bracket.) The other way was expanding Medicaid eligibility, which previously covered a very limited subset of the poor. The ACA said that states would have to expand Medicaid up to 138% of the federal poverty level, and that expansion would be paid for almost entirely by the federal government.
When the Supreme Court upheld most of the Affordable Care Act in June 2012, it ruled that states could decide to reject the Medicaid expansion and the federal funds that come with it. As of the end of 2013, 25 states had decided not to expand Medicaid. That decision will leave millions of Americans uninsured -- people who would have gotten insurance if their state hadn't rejected the Medicaid expansion.
JB: That's half of our states! What does it mean exactly? What are the numbers behind the ramifications of that decision?
SD: We studied the health effects for people who would have gotten insurance in those 25 states. We estimated how many people were likely to stay uninsured, and we found that almost 8 million people would have gotten insurance if those states hadn't opted out. Then we analyzed data on the benefits of health insurance from previous studies, and applied those figures to the millions who will remain uninsured.
What we found is that these states' resistance to expanding Medicaid will have serious health and financial consequences. Between 7,115 and 17,104 people will die per year because of some states' resistance to expanding Medicaid for the poor. More than 700,000 more people will suffer depression, and 422,553 thousand diabetics won't be able to get treatment.
SD: This is also a major women's health issue: 443,677 women will miss a pap smear and almost 200,000 won't get mammograms. And incredibly, because states are refusing to expand Medicaid, 240,700 poor and middle class families will be struck with catastrophic medical bills, which will lead many of those families into bankruptcy.
JB: That's really disturbing.
SD: We also tried to clarify the idea that Obamacare is going to help every American get health insurance. We found that more than 30 million people will remain uninsured even after the ACA is fully implemented.
It's striking that of the almost 8 million people who would have gotten insurance with the expansion of the Medicaid program, one quarter of those -- more than 2 million - are in Texas. In Texas alone, we found that 184,192 more people will suffer from depression, 62,610 people will be struck with a catastrophic medical expense, and as many as 3,035 people will die because of the governor's decision not to expand Medicaid. The day our study came out I got a message from a farmer in Idaho with six children, and she and her husband won't be able to get insurance because the state is opting out. Families are struggling, and without insurance, they're constantly at risk of having an illness turn into a financial catastrophe.
JB: So, this isn't a case of Obamacare failing to service the public. It's not even being given a chance, at least in those 25 states. Why is that? And, even in states where ACA is in effect, there are still many who will fall through the cracks. Your thoughts?
SD: Some Republican governors and legislators feel that it's so important to undermine Obamacare that they're willing to sacrifice the health, and even lives, of their own citizens. At the same time, they're turning down billions of dollars that would help local economies. But some of these states are realizing how much money they're losing by rejecting Medicaid: a recent study by the Commonwealth Fund found that Texas alone will lose more than $9 billion by 2022 because of its decision to reject Medicaid expansion; Florida will lose $5 billion and North Carolina $2.6 billion. There's no deadline for states to accept the Medicaid expansion, so things could change quickly. Already we're seeing states like Indiana, Pennsylvania, and Utah making moves to accept the federal funding, though they're trying to funnel that money through private insurance companies.
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