(HRSA.gov)
9 May 2014. A new report estimates some 1.1 million clients of community health centers will be left without health insurance in U.S. states that choose not to expand Medicaid, as permitted under the Affordable Care Act. The report was prepared by the School of Public Health at George Washington University in Washington, D.C.
A provision of the Affordable Care Act permits states to expand access to the Medicaid program that shares health care finance for lower-income Americans, to enable uninsured people not eligible for original Medicaid yet still not receiving employer-provided health insurance nor able to buy private insurance on state or federal exchange marketplaces. For states choosing to expand their Medicaid roles, the federal government pays the full cost of expansion beginning in 2014 through 2016, reducing to 90 percent by 2020.
The Supreme Court, in its June 2012 decision upholding the constitutionality of the Affordable Care Act, also gave states the option to expand its Medicaid rolls rather than imposing an expanded Medicare mandate on the states. Since then, 24 of the 50 states and District of Columbia refused to expand Medicaid.
Many Americans relying on Medicaid are also clients of community health centers that provide basic medical services to underserved and vulnerable populations. The latest statistics from the U.S. Health Resources and Services Administration (2012) show community health centers serve some 21.1 million patients, of which more than one-third (36%) are uninsured.
The new report from GWU updates calculations from last year on the impact of the patchwork expansion of Medicaid in the U.S. on community health centers. Since last year, New Hampshire voted to expand Medicaid, and more recent data on community health centers from Health Resources and Services Administration became available. As in the earlier study, the researchers drew their material from the Uniform Data System, a set of statistics from data collected at community health centers.
The new research led by Peter Shin, a professor of health policy at GWU, estimates that 1.1 million people served by community health centers will remain uninsured in states that so far refused to expand Medicaid. If Medicaid were expanded in all jurisdictions, says the report, some 5.2 million people served by health centers would have gained health insurance.
Most of the uninsured health center patients are in the South. About seven in 10 center clients (71%) left uninsured live in 11 southern states: Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, and Virginia. Just five of the states — Alabama, Florida, Georgia, Louisiana, and Mississippi — alone account for 35 percent of uninsured health center patients.
“These low-income patients, many of them living in the South, already face significant challenges to obtaining health care,” says Shin in a university statement. “Our analysis suggests these patients will remain without access to affordable insurance, which will almost certainly lead to delays in care and the risk of more serious health conditions.”
The refusal to expand Medicaid has severe financial implications for health centers in opt-out states. The report calculates community health centers in these jurisdictions are losing some $569 million in revenues. In states choosing to expand Medicaid, health centers are expected to receive some $2.1 billion in 2014 to cover the additional 2.9 million patients receiving medical services.
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