The Patient Protection and Affordable Care Act (ACA) is multifaceted and complex—in addition to its goal of containing costs, one of the ACA’s primary mandates is to increase the number of Americans with health insurance. The bill does so through a number of provisions:
- Creating the new Health Insurance Marketplace, exchanges where Americans can purchase health insurance;
- Establishing subsidies and tax credits that encourage both individuals and employees to purchase insurance;
- Prohibiting insurance companies from denying those with pre-existing conditions from insurance plans;
- Expanding Medicaid to cover a larger number of Americans.
Surprisingly to many of the law’s proponents, this last component has become particularly controversial. Medicaid has always been run by each state with guidance and funding from the federal government, and in June 2012 the U.S. Supreme Court ruled that each state has the option of opting out of the expansion contained in the ACA. Many states have taken advantage of that ruling and are refusing to expand Medicaid.
What does the Medicaid expansion do?
Prior to the passage of the ACA, Medicaid provided health insurance for some, but not all, low-income Americans. In addition to having to fall below an income-threshold set by each state, Medicaid recipients were required to meet a number of other conditions, which varied from state to state. As a result, many of the most impoverished Americans were excluded from the program.
Under the ACA, however, Medicaid eligibility was expanded to include all Americans with an annual income up to 133% of the federal poverty level. The federal government will pay for 100% of the expansion in each state for the first three years, and then reduce its share of the cost to 90% by 2020.
Why is that a good thing?
It means that more Americans will be covered by health insurance—and, in particular, the neediest among us will have critical access to care. The Medicaid expansion facilitates the moral obligation of doctors, patients and society to provide and obtain healthcare for all.
Our Jewish tradition teaches us that human life is of infinite value and that the preservation of life supersedes almost all other considerations. Our communities have always provided healing to all their citizens and over the course of history, our communities have been set up to ensure that all citizens had access to health care–doctors reduced rates for poor patients and communal subsidies were established. Unfortunately, not every state has accepted the Medicaid expansion—in fact 21 states have chosen not to expand the program. These states are effectively turning away federal funding and at the same time keeping the number of uninsured in their states unconscionably high.
The decision to expand Medicaid is one made by governors and state legislators. Work to expand Medicaid in your state here!