Monday, September 10, 2018

The pre-existing conditions proxy war

Protection for people with pre-existing conditions is a red-hot button this election season. The public overwhelmingly supports maintaining the ACA's protections, and worries about losing them; Republicans keep assaulting them while pretending not to.

This is the battleground where both political parties have chosen to fight. That's kind of astonishing in poor red states that have expanded Medicaid -- like, say, West Virginia. Joe Manchin, the Democratic senator up for re-election in WV this year, dares not say the words "Affordable Care Act," "Obamacare," or even "Medicaid." Preserving access to health insurance for people with pre-existing conditions is the ground he'll die on.

But Medicaid, as I explore in a post up at healthinsurance.org, is most ofwhat's at stake in West Virginia -- and more generally, in poor red states that have accepted the ACA Medicaid expansion. The expansion is the means by which those states have cut their uninsurance rates in half:

Impact of Medicaid Expansion in Low Income states

State
State rank: median income
Uninsured 2013
Uninsured 2016
Growth in Medicaid enrollment 2013-2018
Marketplace enrollment
March 2018
Total indiv market enrollment
Arkansas
46
17.8%
 9.1%
328,302
61,702
unknown
Kentucky
47
16.3%
 7.2%
637,486
81,023
115,595
Louisiana
49
22.7%*
11.4%*
430,604
93,178
unknown
W Virginia
48
14.2%
  8.8%
189,025
25,205
39,371

*For Louisiana, the uninsured rate is among adults age 18-64, as opposed to the whole population.

That the Medicaid expansion can't be talked about is a measure of the depravity of our politics, the extent to which Republicans have gaslit this debate. So I argue in the HIO piece. Hope you'll check it out.

P.S. One point I should have emphasized more in the HIO piece is that in West Virginia, where Medicaid is a dirty word, enrollees often say they have a "medical card" (which, per below, says nothing about Medicaid). What if Manchin made  his mantra "Pat Morrisey wants to take away your medical card?" It's true. And 29% of state residents have one. Thanks to Simon Haeder for the screen shot.



P.P.S. Also courtesy of Haeder, a list of what Medicaid is called in each of the 50 states -- though it's missing NJ Family Care, used in my home state, so maybe others.

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