What happens to the medicaid expansion when the ACA goes down?

September 19, 2020 7:41 AM

I have a near relative who is a single working age adult who is functionally disabled but does not qualify for disability and who has several expensive lifelong medical conditions. What is likely to happen to the medicaid expansion when the ACA is shut down?
posted by Frowner to Law & Government (2 answers total)

Depends where your relative lives. Some states will take it over with their own tax dollars, other states won't.

It won't be a simple decision: there will be some careful analysis of the prior cost to the public of unreimbursed ER visits and charity care that may show the Medicaid expansion was not as expensive as the price on the tin. There will also be an analysis of the alternatives, as it may result in ACA exchange policy subsidies pushing down the income ladder to where the Medicaid expansion used to operate - and a fair share of people in expanded Medicaid have personal and family resources that could enable them to acquire exchange policies and not become uninsured.

The politics also may not be pure red state / blue state. There are red states that may perceive the net math to be favorable, be subject to effective lobbying by providers who are making money on expanded Medicaid*, or just not want the political pain of creating uncovered people. There are blue states that simply can't raise taxes higher (or much higher) than they already are, especially with the disproportionately heavy impact on blue state tax collections of Covid. (Texas has a lot more room to add revenue than California does.)

*Despite what you may have heard, Medicaid is very profitable for some providers.
posted by MattD at 8:38 AM on September 19, 2020 [3 favorites]

I think that this is the kind of question that is going to make you miserable and also not be very productive right now. We don't know what's going to happen: we don't know whether it will be possible to block the nomination (unlikely, but we need to fight it as if it is), whether the Democrats will win both branches and pack the courts, whether some of the current justices will rule in unexpected ways on some things... we don't know. It's not going to help you to worry about the potentially shattering effects of any particular potential judgment. We will cross those many, terrible bridges when we come to them. Today, I think you should focus on self-care. Maybe take a break from social media. Go outside. Make an apple cake in RGB's memory. (Apple cakes are traditional for Rosh Hashanah. I recommend this one. And then tomorrow, figure out what your role is in this phase of the fight. Because we are going to have to fight like hell for the foreseeable future, and for a lot of us, it's literally a fight for our lives. But we will cross each terrible bridge as we come to it, and panicking isn't going to help.
posted by ArbitraryAndCapricious at 8:45 AM on September 19, 2020 [20 favorites]