Closing the Medicaid doughnut hole – Commercial Appeal

A patient, a burly black man in his 40s who works as a cook, is in the hospital wincing in pain from a staph infection on his leg. He has no health insurance and earns about $15,000 a year.

You would think that the Affordable Care Act (ACA), aka Obamacare, would help him. But no. He falls into Tennessee’s “Medicaid doughnut hole.”

It is but one of many limitations of the ACA being experienced by the working poor, who often are African-American or Hispanic and live in the South. These include people who make too much to go on Medicaid, but not enough to qualify for the new health insurance exchanges. The exchanges are for those who are uninsured or not covered by employers and whose income is at least 133 percent of the poverty level.

The doughnut hole was created when the Supreme Court gave states the right to decline Medicaid expansion for the uninsured under the ACA. Tennessee and 25 others, mostly Southern Republican states, decided not to expand Medicaid. Republican-led legislatures argued that Medicaid is an expensive and broken program: “Why expand it?” Correctly so — TennCare consumes nearly one-third of the state’s budget, and expanding it would add a $200 million burden to the state over 2014-2019, even with the federal help.

But by not expanding Medicaid, we also pay a heavy toll. The doughnut hole causes a gap in health coverage for a large population. Eight million poor people fall in the doughnut hole in America, 360,000 in Tennessee and some 37,000 in Shelby County.

Not expanding Medicaid primarily hurts two vulnerable populations: black people and women. Two-thirds of poor black people and two-thirds of poor single mothers in Tennessee who do not have insurance fall through the doughnut hole and have no financial support to purchase health insurance. Not expanding Medicaid also hurts rural Americans. Forty-one percent of poor Americans living in rural areas do not have health insurance, and 2.6 million of them could gain it through Medicaid expansion.

Arkansas, our neighboring state with similar political views and with a Republican legislature, has found a way out of the doughnut hole. The Obama administration has approved the use of federal Medicaid expansion money for the purchase of private insurance from the exchanges for Arkansas residents who fall in that state’s doughnut hole. If Tennessee had a similar program, it would cover my patient, who fits the criteria — age 19 to 64 with an income up to 133 percent of the poverty level ($15,280 for an individual).

Many insiders in Tennessee politics tell me that Gov. Bill Haslam, who is more of a businessman than an ideologue, favors some form of Medicaid expansion because it will help the state’s economy.

My uninsured patient is a case in point. He got his leg infection treated with intravenous antibiotics, leaving the hospital with a unpaid bill of more than $30,000. The Tennessee Hospital Association estimates that without some type of Medicaid expansion, Tennessee will feel $13.3 billion in recessionary impact to the state’s economy with potential loss of 90,000 jobs and loss of $6.4 billion in federal dollars.

I have a bit of a selfish perspective on the Medicaid expansion. If we fail to take these federal dollars, which come from our federal taxes, then our tax dollars will go to help the Medicaid expansion in California or Massachusetts and not to those who need it in our state.

The ACA, like any large piece of legislation, has its successes (preventive services and competition in exchanges) and its limitations (the doughnut hole and burden on the state). It is undoubtedly far from being an ideal piece of legislation, but if the governor and the state legislature choose the Arkansas “private option,” it can help thousands of poor in our state from falling through the doughnut hole, and help the state’s economy.

Source : Commerical Appeal