No matter how hard we work to understand how to pay for health care, the odds are stacked against us. Health insurance in the U.S. is intentionally hard to understand. Political discussions on health insurance frequently escalate into matrices of strained feelings and damaged relationships. Furthermore, with constantly changing terms like “Open Enrollment,” “co-pay,” “premium” and “deductible,” it is possible that health insurance makes no sense at all. Specifically Medicaid.
After all, what’s the difference between the Affordable Care Act, Obamacare and Medicaid?
Health insurance for folks under the age of 65 is either private or through Medicaid (López, 2019)*. If a health insurance someone is enrolled in is private, it means that one’s work covers their health insurance. More and more frequently, Americans aren’t working in full-time jobs that have to give employees health insurance. Jobs that don’t provide insurance are freelance, in the service industry, or part-time. For most of these jobs, health insurance isn’t a part of the policy. Medicaid was built for those who don’t have the wealth privilege of having private health insurance.
Medicaid is entirely different from Medicare. Medicare is the federal health insurance plan for folks who are 65 or older. Basically, you pay for it through Social Security until you turn 65. At that point, you can apply for a version of Medicare that suits your health needs. Medicare is a way in which the country cares for folks who are over the age of 65.
Medicaid is a federally-funded, state-led health insurance program for the indigent. Medicaid is designed to be an aid service program for those who need it. Federally, the program is a part of the Center for Medicare and Medicaid Services, or CMS. The CMS outlines who can be covered by insurance, and how the benefits work. It’s covered by Federal Social Security.
A citizen’s interaction with Medicaid depends entirely upon where they live, as Medicaid is a federal program lead by each state. State Medicaid agencies run the programs with citizens and distribute out benefits. All states must participate in Medicaid. In Missouri, our Medicaid Branch is called Mo HealthNet. However, citizens still apply for Medicaid through HealthCare.gov. The website can also be called the “Marketplace.”
The Obama Administration created the Medicaid program through the Affordable Care Act (ACA), meaning that you qualify for care if your household income is below 133% of the federal poverty level. As a heads up, the federal poverty level is very, very low. The disconnect between what the federal poverty level is labeled as and what the income level is for experiencing symptoms of poverty means that many Americans are cropped out of health insurance coverage.
In 2012, Medicaid was set to expand to cover more Americans for health care. However, 14 states chose not to expand their programs to cover more citizens. Missouri was one of the states that opted out of expanding Medicaid. This decision left hundreds of thousands without health insurance.
In Missouri, we have this thing called the “Medicaid Gap.” Rachel Garfiels, Kendal Orgera, and Anthony Damico discussed the Gap in their article for the Kaiser Family Foundation:
“Medicaid eligibility for adults in states that did not expand their programs is quite limited:… in nearly all states not expanding, childless adults remain ineligible. Further, because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults, including all childless adults, fall into a “coverage gap” of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits.”
There are 124,000 Missourians currently in the coverage gap, meaning that over 100,000 people are unable to qualify for health insurance through Medicaid. Most of these folks are People of Color, widening health disparities based on race. The percentage of uninsured folks decreased by 36% from 14.1% to 9.0% of the population in the years leading up to 2018.
Without health insurance, health care is exorbitant. For example, without health insurance, giving birth alone can cost up to $50,000 for a C-section. With health care costs rising significantly over the span of years, it’s likely that giving birth, along with every other health procedure, is more expensive than what it was even 5 years ago.
Though giving birth is an extreme example, it provides insight into what living costs to not have health care paid for. Prescriptions are expensive. Doctors’ appointments are expensive. Braces are expensive.
If they don’t have health care paid for, Americans have two options:
Don’t seek medical attention or care when they need to- skipping STI testing, screenings, and other types of health care that keep people healthy. Every year, 45,000 Americans die because they couldn’t afford medical care.
Seek medical care when they need to, and run insatiable financial and legal risks for bills they can’t afford.
Let’s say you don’t have health insurance because you’re in the nearly 10% of Missouri citizens who cannot be covered. While you are uninsured, you give birth. Though the birth is without a single complication and your baby does not need NICU care, the bill calls for you to pay $22,734.
For big-ticket hospital bills, folks who cannot afford the bill face incredible odds.
A bill is sent to private Collection Agencies, who will set up a payment plan to work off tens of thousands of dollars in debt. These agencies will lower folks’ credit scores, making it more difficult to apply for insurance, financing a house, or purchasing a car.
If someone can’t afford to pay off their debt and doesn’t work with collections on the bill, it will be sent to court. If the debt is deemed valid, the agency will probably obtain a writ, which will take one’s wages and possess their property.
A common argument against Medicaid is that taxpayers pay too much for other people to get health care. People don’t want the federal government being more involved with the healthcare system than it was before 2010. Furthermore, it seems a lot of people have negative perceptions of Medicaid because of its colloquialism, Obamacare. People think it’s unfair for folks who don’t work to get health care that they pay for. After all, even folks with private insurance pay for Medicaid through payroll deductions and taxes.
People don’t choose to live without healthcare coverage. During the government shutdown in early 2019, the coverage of 9 million children through CHIP was at stake. Living without health insurance makes existing a class privilege. Restricting who can afford healthcare siphons care from low-income and oppressed communities, specifically low-income folks of Color.
20% of our Gross domestic product goes to healthcare spending. Health costs are rising, and more and more people are unable to afford it without insurance. Income-based accessibility enforces the reality that it is currently a privilege in the US to have access to health care, exacerbating manifestations of structural racism.
As Americans, we must hold each other and our country accountable to keep people not only alive, but healthy. Americans deserve to give birth in a hospital, and to have access to EpiPens, insulin, orthodontic braces, birth control, SSRIs, in-patient coverage, therapy, HIV testing, vaccines, OBGYN appointments and general check-ups. We all deserve to access healthcare. Health care is a right.
In 2017, 74.6 million Americans were able to get health insurance because of Medicaid. There are 14 states that could raise that number by expanding Medicaid. We must push them to do so.
*López, J. PhD. (2019). Government Health Insurance Programs: Medicaid, CHIP, and Medicare [Powerpoint slides]. St. Louis, MO: Saint Louis University. PUBH4000.