Affordable Care Act has been passed and significantly improved healthcare systems in the United States. The ACA has divided its Quality Health Program into four levels based on the cost sharing. There were four levels: bronze, which must share 40% of the out-of pocket costs with policyholders; silver, gold, and 20% respectively, along with platinum, at 10%. (Kominski et al.,2017)
The ACA offers two routes to coverage. First, state-level markets in health insurance based on choice and competition. Individuals could compare different plans to find the most suitable one. This included coverage for low-income persons and people earning below 400% of the Federal Poverty Line. Subsidized were available to make purchasing easier. The ACA extended Medicaid eligibility to all households that earn up to 138% FPL. (Mclntyre & Song, 2019)
The ACA reshaped private insurance through the establishment of new minimum federal consumer protection that prohibited insurers against discrimination based on one’s health status; they were not allowed to change or turn away individuals’ premium based on pre-existing medical conditions. Another law that permitted children to receive the parent’s health insurance was the dependent coverage law. It allowed them to do so until they were 26 years old. (Mclntyre & Song, 2019)
Many states complied to the expansion policies of the ACA. Others did not. There was a discussion motion on whether Medicaid should be expanded in the states. Some expansion states used the federal currency to purchase private healthcare insurance that covered low income people, instead of traditional Medicaid. (Sommers et al., 2015)
Anyone who wants to enroll in a government-run program for insurance will find many reasons why the Medicaid expansion program remains inadequate. Millions of Americans still lack insurance, despite the fact that the law has not changed. The exchange is at risk because few insurance providers will be participating in it, which reduces the competition needed for reasonable prices. Another concern is that insurers will find alternatives to evade prospective customers despite the law’s mandate to have them cover everyone. (Field, 2015)
The entire cost of Medicaid expansion was paid by the federal government in compliance with ACA. With a 10% allocation cost for 2020, the expansion plan allowed states to start covering expansion costs starting in 2017. Multiple states could be hit with an average cost of $100 million. All states that approved the Medicaid expansion program had their citizens benefit. The benefits included improved physical and economic wellbeing of the low-income citizens, reduced rate of uncompensated care especially in Michigan and a boost to states economy through job creation & economic stimulus. (Buchmueller et al., 2020)
Texas’ Medicaid eligibility was restricted in 2014 for people with disabilities, those making less than 75% Federal poverty (earns less 9000 annually), pregnant women who make less than 2000% Federal poverty (earns just below $23500 each), parents earning 19% or less federal poverty (each family of four earns $5000 per annum). Sommers (2016) reports that Medicaid is only available to 17% of Texas residents. However, 32% live below the federal poverty level. This indicates that Texas has a need for an expansion program. The 2020 Medicaid State Fact Sheets. For fiscal 2020-2021, the state budget totaled $ 66.5 trillion. This represents an increase from the $64.2 million budget for the preceding financial year. Still, the Medicaid Program Administration managed to save $ 0.2 billion during the state’s fiscal years 2020-2021. (Allen, 2019)
Medicaid waivers are also known as 1115 waivers and 1915 waivers. These waivers include waiver programs and home- or community-based services waivers. Programs that improve efficiency or cover can be demonstrated under the 1115 waiver. Sub-categories can be found under section b or c of the 1915 waiver. The Section 1915 (b), waiver gives states permission to set up a Medicaid coverage plan. The section 1915(c) permits beneficiaries to access long-term care at their home. A combination of 1915(1) and (1915(2)) will enable them access to both 1915 (b) and 1915 (c). (Montgomery & Sulivan, 2020) As of October 31 2018, 37 states had active sec. 1115 waivers were granted, and more than one-third of Medicaid dollars was directed toward sec. 1115 programming. Sec. Section. Section. The Centre for Medicare Services, and Medicaid Services will approve waivers previously rejected by previous administrations. (Underhill, 2018) Among the issues, the waiver seeks to address include behavioural health, healthy behaviour incentive& benefit restrictions, and work requirements along with eligibility & enrollment restrictions. (Hinton et al., 2019)
Texas can also exclude providers of abortion, which allows it to block providers from enrolling in Medicaid. (Grusin, et. al. 2020). These strategies can help states to make more informed decisions on how to provide affordable medical care for those with low incomes. Texas is currently covered by the Social Security Act Section 1115 waiver for family planning. Texas can limit the number of family planners it allows. 2020 (Medicaid Waiver Tracker, Aproved Section 1115 Waivers by States, 2020
Texas is not part of the Medicaid expansion plan. This makes Texas an appealing alternative. It currently serves more than 2,000,000 uninsured people. Sec. The sec. These individuals are not able to afford a healthcare plan but make up a large portion of Texas’ population. (Chen et al., 2019)
Special interest groups that include lobbyists, as well as other public representatives should participate in expanding Medicaid. Because the public requires an expanded Medicaid program and lobbyists will be the most effective way to get Texas to agree with the expansion bill, Also, the bill will require drastic modifications and an assessment. The bill also requires reimbursement of healthcare workers in order to be eligible for the Medicaid expansion. The process will involve an application for the waiver expansion, approval & implementation, evaluation and litigation.
Arkansas borrowed the Medicaid expansion idea from Texas. Recent approval was given by the federal government to the plan in section. The plan stipulated that Medicaid adults Medicaid recipients must work. Arkansas was unique in its premium assistance strategy for Medicaid expansion. It saw the rate of uninsured drop by half. More than 300,000. Arkansas Medicaid expansion was built on an existing work requirement. This communication plan helped enrollees to understand the requirements as well as how they could maintain their coverage.
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