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. Bronze, where policyholders must contribute 40%, silver (30%), gold (20%), and platinum (10%) were the levels. (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. The plan also covered health insurance that included low-income people and individuals earning less than 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. The dependent coverage law allowed children to be covered by their parents until the age of 26. (Mclntyre & Song, 2019)
Many states complied under the ACA’s expansion policies. Others did not. The state debated whether to expand Medicaid. Some expansion states used the federal currency to buy private healthcare insurance that covered low-income individuals instead of traditional Medicaid. (Sommers et al., 2015)
If you are looking to join a government run insurance program there will still be many issues. Millions remain uninsured, though the law still applies. 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)
In accordance with ACA, the entire cost for Medicaid expansion was covered by federal government. This expansion plan would have allowed the states to cover expansion costs beginning in 2017 and a 10% responsibility cost for 2020. Multistates could spend an average $100 million. The Medicaid expansion was approved by all 50 states. This program has been a huge success for their citizens. 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)
In Texas, Medicaid eligibility has been restricted since 2014 to persons with disabilities or those who earn less than 75% federal poverty. Pregnant women earning below 2000% federal poverty are paid just less $23500 per woman. Parents making 19% federal poverty ($5000 for four families). Sommers (2016) states that Medicaid is currently available for 17%, while 32% of Texas’ residents are below the federal poverty limit. This indicates that Texas has a need for an expansion program. (Medicaid State Fact Sheets, 2020). 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. However, the Medicaid Program Administration managed to save $ 0.2 billion during the state’s fiscal years 2020-2021. (Allen, 2019)
Medicaid waivers could be defined as either 1115 waivers, or 1915 waivers. Also included are home-, community-, and program-based waivers. Programs that improve efficiency or cover can be demonstrated under the 1115 waiver. Part b and part c can sub-categorize the 1915 waiver. Section 1915 (b), waiver allows states to establish a Medicaid plan. A beneficiary can receive home-based long-term medical care under section 1915 (c). A combination of 1915(1) or 1915(2) allows 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. Sec. (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, giving the state the power to decline providers from 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 is able to limit who can be a family planner. (Medicaid Waiver Tracker Approved, In Process Section 1115 Waivers by State, 2020).
Texas isn’t included in the Medicaid expansion plans, making it an attractive alternative for lobbying to expand. It currently serves more than 2,000,000 uninsured people. Section 1115 waiver would allow legal immigrants with incomes below 138% to be eligible for Medicaid coverage. Section 1115 would permit legal immigrants to receive Medicaid coverage if their income is below 138%. These individuals are part Texas’s largest population and cannot pay for a healthcare plan. (Chen et al., 2019)
Lobbyists and other representative of the public, should all be part of 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. To enable the Medicaid expansion, healthcare workers will need to be reimbursed. The process will involve an application for the waiver expansion, approval & implementation, evaluation and litigation.
Arkansas borrowed from Texas the Medicaid expansion plan. The federal government approved the plan recently under 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. The program enrolled over 300,000. Arkansas Medicaid expansion was founded on an existing job requirement. This communication plan helped enrollees to understand the requirements as well as how they could maintain their coverage.