A key provision of the Patient Protection and Affordable Care Act (ACA) mandated that all States expand eligibility of Medicaid coverage to all individuals with income up to 133% of the poverty line (about $29,000 for a family of 4), effective January 1, 2014. On June 28, 2012 the Supreme Court, while upholding the constitutionality of ACA, ruled that the federal government cannot require states to expand Medicaid and that each state can opt in or out.
This option has caused intense debates in many States whether to expand Medicaid. Unfortunately, in many cases the discussion has been influenced more by political considerations, than a concern for the weakest member of society.
In the Western Region, some States have already opted to expand Medicaid benefits: California, Washington, Hawaii, and Nevada. In Montana, while a thin legislative majority would have approved the expansion, a voting error caused its rejection, just before the legislature adjourned for two years. In Oregon, the issue is still being debated. In Idaho, Utah and Alaska, currently, there is no political will to go ahead with the expansion, in spite of strong support shown by the population.
In Arizona, Governor Brewer embraced Medicaid expansion, but the majority of the Legislature is adamantly against it, not even allowing a bill to get to the floor. The issue has created a sharp division between the Governor and her own party. Some moderate members of the majority, who have announced their support for the expansion, are now under extreme pressure to change their position, including threats by their party to withhold future electoral support.
The legislative majority is against Medicaid expansion for purely ideological reasons, ignoring the need of their constituents and the economic realities. In Arizona, the implementation of Medicaid expansion will have the following economic benefits:
— provide medical insurance coverage to an additional 250/300,000 people
— bring to AZ Federal funds of $1.6 billion, annually
— create an estimated 21,000 jobs in the Healthcare industry
— save hospitals (especially rural hospital) from bankruptcy
In addition, if no action is taken, 63,000 low income Arizonans will lose their current healthcare coverage on January 1, 2014, including cancer patients and those with serious mental illness.
The Governor is still trying to work with the legislature on this issue. As an alternative, she might get Medicaid expansion approved as part of the State budget process. If that also fails, Medicaid expansion might become the object of a referendum initiative in the future.
Through our home visits, we hear how serious medical problems can push people further into poverty and how lack of preventive medical attention makes mild medical conditions spiral out of control, until they find their way to hospital emergency rooms.
With Medicaid decision impacting so many of the people served by SVdP, Voice of the Poor members from Phoenix and Tucson wrote and visited their legislators multiple times in support of the expansion. In addition, Voice of the Poor is coordinating nationwide its advocacy efforts towards Medicaid expansion with Network, the National Catholic Social Justice lobby (nuns on the bus).
This issue is key to SVdP in every State, due to the high number of people in poverty affected. We, Vincentians must commit to advocate decisively and incessantly and to dedicate to it all our efforts, until a favorable decision is made in each state.