Articles Posted in Affordable Care Act

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Medicaid is the federal government health insurance program for people in poverty.  Before the Affordable Care Act (ACA) individuals qualified for this program if they lived at about 64% of the federal poverty level.  In 2023 the federal poverty level is $13,590 for an individual.  The ACA allowed states to expand eligibility for Medicaid to 138% of the federal level (about $18,754 for a single individual in 2023).

To date, forty states have expanded Medicaid.  The states that did not adopt Medicaid are:  Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.  South Dakota has adopted but not implement Medicaid expansion.

The American Rescue Plan Act (ARPA) of 2021 provided financial incentives for expanding Medicaid. The coronavirus pandemic adversely affected health outcomes through lack of access to healthcare and increased mortality.  Coverage options for many low-income adults are limited in non-expansion states.

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Centuries old downtown Atlanta hospital, Wellstar Atlanta Medical Center (formerly Georgia Baptist Hospital) is scheduled to close in November of 2022.  Wellstar claims it could not continue to operate the hospital at a loss.  Wellstar AMC claimed more than $262 million in uncompensated indigent care in the most recent years reported.  The national labor shortage also affected the hospital.  AMC has 460 beds, but could only staff 200.  Wellstar contends that closing AMC will allow it to fully staff other Georgia Wellstar hospitals.

Georgia remains a state that has not expanded Medicaid under the Affordable Care Act.  Under full Medicaid expansion, an estimated 500,000 Georgians would gain coverage.  Axios Atlanta reported last month that some Georgia Republicans are quietly changing their minds about Medicaid expansion.  Expanding Medicaid would allow for 90% federal health insurance coverage for low income residents.  Georgia is one of 12 states that have not expanded Medicaid under the ACA.  If passed, an estimated 500,000 Georgians would gain coverage.  Poll show that a majority of Georgians support expansion.

Two factors have influenced the shift in political thought on Medicaid expansion:  hospital closures and COVID-19.  Eight rural hospitals have closed in addition to AMC downtown.  Medicaid coverage would have added revenue for those uninsured requiring care.  Second, COVID-19 federal funds for hospitalized patients will end soon, causing a loss of coverage for over 250,000 currently insured.

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As 2021 draws to a close, Georgia ranked 50th this year, ahead of only Oklahoma and Mississippi in health care.  The Medicare Guide on senior health care analyzed prescription drug prices, the number of physicians in relation to the state’s population and life expectancy.  Georgia ranked 51st in access to care. One problem with access to care is that many rural counties lack physicians.  Nine of the 159 counties have no doctors.  Seventy-six counties have no OB/GYNs and sixty counties have no pediatrician.  In health outcomes, Georgia ranks 47th, particularly due to infant and maternal mortality rates.  Inequities in care and access to care impact the low numbers on health outcomes.
Georgia Demographics

As of 2021 Georgia had a population of 10,830,007 citizens.  This increased 18.3 % from the 2010 census.  Georgia has the 10th fastest growth rate.  Although all of Georgia is not growing.  The counties with the highest growth rates are grouped together along the southeastern border and along the northern border in and around the capital of Atlanta.  However, there are declining populations from the southwestern border through middle Georgia to the mid-eastern border of Georgia.  Georgia has a 15% poverty rate.   As of 2021, Georgia’s population under 18 is 23.6%; the population over sixty-five is 14.3%.  Eight percent of Georgians under age 65 are disabled.

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First, right before the holidays, Congress approved another short-term funding bill, funding the government through January 19, 2018.  Congress did fund the Children’s Health Insurance Program through March 31, 2018.  I have previously blogged on the importance of funding that program.  More on that as we head to March.

The final version of the tax bill repealed the penalty for not having health insurance (“the individual mandate”) that was an important part of the Affordable Care Act.  The structure of providing low-cost, affordable and portable healthcare available to all Americans depended on everyone — young and healthy alike — purchasing healthcare.  Not only does this control costs for the consumer and risks to the insurance provider, but it reduces the number of uninsured Americans.  Sure, many healthy young adults balked at the mandate.  But since even these individuals cannot rule out getting hit by a bus or injured in an accident, it was hardly an onerous federal regulation.

But Congress eliminated it so there you have it.  According to the National Budget Office, the repeal of the individual mandate will cause 13 million fewer people to be insured by 2027.  Some people will elect not to purchase coverage and some will not be able to afford coverage.

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