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LETTER TO THE EDITOR: Lack of Medicaid expansion stands in the way of health care success

Monday, August 4, 2014 | 12:17 p.m. CDT

The July 17 issue of the New England Journal of Medicine contains a comprehensive, evidence-based analysis of the effects of the Affordable Care Act.

Researchers at the Commonwealth Fund estimate that 20 million Americans gained insurance coverage under the ACA as of May 1; most were previously uninsured.

Claims that many who signed up for insurance would not pay the premiums have been refuted. A huge majority of signees paid the first month’s premiums.

Participation by young adults is sufficient to obviate the need for large increases in premiums. Recent surveys have found dramatic reductions in the number of uninsured Americans, and the nonpartisan Congressional Budget Office projects that the law will decrease the number of uninsured people by 26 million by 2017.

The ACA is at least partially responsible for the substantial slowing of the rate of increase in health care costs in recent years.

Unfortunately, some states, including Missouri, have refused to expand Medicaid coverage as provided by the ACA, depriving 5 million low-income Americans of medical insurance and creating serious hardships for hospitals.

Recent studies have documented the benefits accruing to states that have expanded Medicaid coverage. In a national survey, the Colorado Hospital Association found significant decreases in uncompensated hospital care in states that expanded Medicaid but no change in states that did not.

In the absence of Medicaid expansion and with reductions in government subsidies for charity care, hospitals in states like Missouri are laying off workers, and some are closing. Efforts in Washington to mitigate the economic harms of failed expansion by continuing the subsidies have been defeated by Congressional Republicans.

In the face of implacable, and often irrational, political hostility, the ACA has exceeded expectations by extending insurance to millions of Americans. The ACA faces challenges and uncertainties, and problems — both real and imaginary — will be exploited by opponents.

The many serious weaknesses of the U.S. health care system will not be easily or quickly resolved, but with the ACA, we are moving in the right direction.

Robert Blake, MD, lives in Columbia.


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