Capstone Project: aftermath of choosing to not expand Medicaid

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[. . .] The first group includes people, who earn an income that is above the placed limit for subsidies for premium tax or those who have an affordable cover offer from their employer. Some among the lot can purchase affordable but unsubsidized cover in the marketplace. The second group includes undocumented and uninsured immigrant individuals. It should be noted that 16% of North Carolinians that are not elderly are not eligible for help under ACA and are prevented from buying coverage via the Marketplace (Glied, Ma & Borja, 2017). Although the above group will still have needs for health insurance, they will remain not covered by insurance policy.

NCs decision not to expand Medicaid made it lose the chance to provide help to many individuals who are uninsured. A lot of people that are eligible for coverage under an expanded program remain uninsured. In addition, the effect of ACA will be determined by the rate at which uninsured individuals decide to take up such coverage Efforts to enroll uninsured individuals and outreach programs will also play a significant role in the way the uninsured are affected by the law. Although ACA contains a requirement that most people should be covered, some people are exempt while others remain an uninsured lot. No deadline has been put in place for the implementation of Medicaid by the state. Open enrolment goes on through March in 2014 (Glied et al., 2017). Paying attention to the individuals eligible for coverage as the process of implementing ACA continues can help to influence decisions for future coverage in the state of North Carolina.

Economic cost to hospitals

Increased private health care insurance coverage combined with Medicaid is expected generate revenue from hospitals that will offset $22 billion Medicaid cuts by ACA to disproportionate share of payments to hospitals, a corresponding $34 billion in disproportionate cuts by Medicaid and $260 billion in fees for service cuts implemented by Medicaid in the season 2013 to 2022(Dorn et al., 2014). Comparatively, in states that are not expanding the program, healthcare facilities will foot the bill for all funding mechanisms by ACA. They will, nonetheless still receive a part of the increased revenue earnings for those who are newly insured which was part of the original plan of ACA prior to the decision by the supreme court making expansion of Medicaid an option for states to choose. The states that remain as they were before the program was launched are projected to make their hospitals to lose out on Medicaid revenue of up to $15.9 billion in revenue for Medicaid in the period running through 2016. The total revenue forgone from 2013 to 2022 is projected to hit $167.8 billion (Dorn et al., 2014). These figures would have increased payments by Medicaid by 32.3% and 30.7 respectively for the states’ hospitals. Expansion of Medicaid increased costs in hospitals by enhancing utilization. Furthermore, the expansion slightly reduced the private insurance revenue for hospitals through raising the lower caps for financial eligibility for subsidies from the Marketplace from the previous 100 to 138% FPL. That notwithstanding, the two factors are clearly outweighed by higher Medicaid revenue that is generated as a result of the expansion.

It is clear that expanding Medicaid would help lend significant financial stimulus to North Carolina. This would happen courtesy of the jobs that would be created, reduced costs at state level among others. The state has already lost out on billions it would have benefited if it had expanded Medicaid. It has also lost out on a significant number of jobs it would have created. There are still many gains it can make if it expands the program now. The researchers have summed up the total revenue lost in federal funds as a result of North Carolina declining to expand Medicaid to stand at $6.02 billion (Ku et al., 2014). It has also been projected that the state will lose another $21 billion from 2016 to 2020 if it remains adamant about Medicaid expansion. It is worth noting that both state and local authorities have lost out $228 billion in revenue. Further, the counties would have made an additional $40 million (Ku et al., 2014). If the state does not expand Medicare, the total tax revenue lost out will stand at $862 million. The reduction on county tax revenue is projected to stand at $161 million. Many independent experts have estimated that if North Carolina had expanded Medicaid in 2016, the total number of jobs it would have generated is between 20 000 to 40 000 by 2020. A report by Cone indicated that nearly 30 000 jobs have been lost in the period between 2014 and 2015. If the state still refuses to expand the program, up to 40 000 jobs will have been forfeited by the 2020 mark (Conover, 2017; Ku et al., 2014). It has been pointed out that nearly half of the jobs would be in healthcare. The remainder would be in such fields as retail, construction, there service industry and in government. All the hundred counties would feel the employment effect.

Expanding Medicaid would also lower the cost care that is uncompensated for hospitals. In practice, state owned hospitals such as the University of Carolina Hospital would have medical bills settled for thousands of patients that would have never raised the amounts incurred in the course of the healthcare services extended to them. The experts point out further that up to one third of the uncompensated medical costs in the state would have been averted if Medicaid would have been expanded. The total savings made from these payments are estimated to be about $250 million between the years 2016 and 2020(Glied et al., 2017; Ku et al., 2014). Further, the state would have saved another $934 million in averted costs in the programs of mental health covered by Medicaid. Indeed, hospitals in rural locations have complained for a long time that they were negatively affected by the failure to expand Medicaid. The move, they say, undermines the ability of the hospitals to serve the public better. The research corroborates these concerns (Glied et al., 2017). Research by the University of North Carolina Chapel Hill showed that hospitals noted a better chance to generate profits if they were within a state that expanded the Medicaid program. Indeed, hospitals that were under stated that expanded the program generated more revenue compared to those that were in states that declined to expand the program. City hospitals did not show similar improvement though. Generally, it can be concluded that hospitals were better of under the expanded Medicaid programs. Further, it is also worth noting that rural hospitals gained much more from the expansion.

Disease prevalence by those with no insurance

ACA of 2010 is meant to provide healthcare insurance coverage to those who were previously uninsured in America. Medicaid coverage will be granted to adult Americans with an income below 138% of the federal poverty level (Brown & McBride, 2015). Those with incomes that exceed the set poverty level margins can access insurance policy plans through private insurance organizations in the marketplace. Premiums for the marketplaces are subsidized for individuals with household incomes ranging between 100% and 399% of the federal poverty level. It has been estimated that up to 60% of people that are uninsured will gain health insurance either of the two methods by 2019 Figures show that by 2014; ACA had seen a decline of 9 million in the number of uninsured individuals. There was no separate data for individuals with diabetes.

Previous studies show that individuals who are uninsured face notable barriers to getting healthcare and are faced with more costs for healthcare out of their pockets compared to individuals insured individuals (CDC, 2015). Additionally, uninsured people often experience health issues for extended periods as a result of lack of access to medical assistance. While much research has been concentrated on the uninsured population in general, few studies have been done on the diabetic population. There was a study that also focused diabetes and Medicaid, even though older data was used in the study. People with higher incomes and also affected by ACA were also excluded. Owing to the fact that healthcare reform, being a major social public policy in decades is in the process of implementation, there are few studies that have focused on the US population with diabetes that remains uninsured and made observations on how their health coverage is shifting under the ACA implementation as from 2014 and yonder. The effects of failure to expand Medicaid in North Carolina mean that the poor people will remain without medial cover. In the end, it is expected that the disease prevalence will remain the same in the state.

Stroke, cancer, heart disease and chronic lung disease are the main death causers in NC. 60% of all deaths in the state are caused by chronic… [END OF PREVIEW]

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