In the banquet of spending cuts laid out as part of the debt negotiations, everyone seems to want a piece of Medicaid. Congress and the Administration are hungry for $4 trillion in savings, and while a powerful voting bloc of seniors helps protect Medicare, Medicaid serves people whose voices at the ballot box aren’t typically feared by those in Washington: the majority of Medicaid beneficiaries are women, children, and people with disabilities, many of them people of color, and all of them familiar with how poverty can cut off access to lifesaving medical care.  

Medicaid works

Medicaid provides coverage for more than 50 million Americans. In a recent poll, more than 50 percent of respondents shared that they have a personal connection to Medicaid, either because they themselves have received assistance from the program at some point in their lives or because a friend or family member had. Other recent research demonstrates that Medicaid makes a huge difference in people’s lives. Compared to people without insurance, Medicaid beneficiaries are happier, healthier, and have more access to the routine health care that prevents public health tragedies like high infant mortality, soaring costs for uncompensated emergency room visits, and unnecessary deaths from controllable conditions like diabetes and heart disease.

The Affordable Care Act recognizes Medicaid’s importance as a central part of the safety net and slates the program for a big expansion. The health reform law includes a requirement that states maintain current eligibility levels for their Medicaid programs, and beginning in 2014, an estimated 16 million currently uninsured people will receive coverage under Medicaid.

The future of Medicaid includes the LGBT community

Many lesbian, gay, bisexual, and transgender people and their families will be among these new beneficiaries. Currently, most states do not consider childless adults, regardless of their income, eligible for Medicaid benefits. As a result, Medicaid probably covers few LGBT people at the present time, though a lack of data collection on sexual orientation and gender identity on most nationwide health and insurance surveys makes the number of current LGBT Medicaid beneficiaries difficult to estimate. Because many LGBT people have incomes that fall within the new nationwide eligibility standards (under 133% of the federal poverty line), however, there will likely be a significant proportion of LGBT adults added to the Medicaid rolls in 2014.

Despite popular stereotypes, poverty and un- and underemployment as a result of discrimination are persistent problems for LGBT people and their families. Recent studies indicate that poverty rates among LGBT Americans are higher than those among the heterosexual and non-transgender population. Lesbian and bisexual women experience poverty at a rate of 24%, compared to 19% among heterosexuals, while a recent survey indicates that transgender individuals make $10,000 a year or less at twice the national average, simply because of who they are. Employment discrimination on the basis of sexual orientation and gender identity results in higher rates of un- and under-employment rates for LGBT people as compared their non-LGBT peers. Even among those who are employed, a significant wage gap between lesbian and gay employees and their heterosexual coworkers persists, and uninsurance remains high in the LGBT community in no small part because few employers extend insurance coverage to their employees’ same-sex partners.

Another recent development has made Medicaid even more important for the LGBT community, which continues to bear a disproportionate burden of the HIV/AIDS epidemic: in June 2011, the Centers for Medicare and Medicaid Services released guidance to states on using Section 1115 Medicaid waivers to extend coverage to people living with HIV or AIDS before they become sick enough to qualify as disabled. This guidance provides a lifesaving bridge to 2014 for adults with HIV or AIDS who do not meet their state’s current Medicaid eligibility requirements.

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Kansas is losing notoriety. Once the only state trying to shut down all of its abortion clinics, Kansas may soon be overtaken by Arizona if its Republican lawmakers have their way. Earlier this year, the Arizona GOP passed two laws that aim to expand — and effectively ban — what constitutes a medical abortion. Up until now, Arizona law required surgical abortions to be performed by a doctor, but allowed certified nurses to administer RU-486, a drug that induces abortion within a few days. The new laws, however, not only require clinics that perform abortions via RU-486 to adhere to the same requirements as those that perform surgical abortions but also prohibit nurse practitioners from administering the drug. In doing so, Planned Parenthood — which filed a lawsuit to challenge the laws’ constitutionality — points out that Arizona is effectively banning abortions in three cities:

The new laws extend all the requirements for a surgical abortion to a medical abortion. While that includes the mandates for equipment and personnel that must be present, the biggest change is that nurse practitioners will no longer be able to perform the procedure.

Planned Parenthood, in its lawsuit, says that would mean no more abortions performed in Flagstaff, Prescott and Yuma which are staffed only by nurse practitioners. They also said it will mean unnecessary delays in the procedure for patients in the Tucson and Phoenix areas, as women who otherwise could get a medical abortion from a nurse practitioner now will have to wait until a doctor is available.

Bryan Howard, president of the organization, said these bills and others in prior years are all designed to make it impossible for women to exercise their constitutional right to decide whether to carry a baby to full term.

Planned Parenthood also noted that “about half of the abortions in Arizona are performed through medication.” Nurse practitioners and physician assistants “have been providing this care in Arizona for over a decade with exemplary quality and safety ratings,” said Planned Parenthood Arizona CEO Bryan Howard. “There is not medical evidence that they should be prohibited from providing the care. And we know that given the shortage of physicians willing to provide this care, it will have a significant impact and place a burden on patients.”

Arizona’s recent legislative history is riddled with extreme attacks on this constitutional right, including the first law to send doctors to jail for performing abortions based on race or gender. However, state attorneys have agreed to hold off enforcing medication abortion laws to hear Planned Parenthood’s argument. That hearing is set for Aug. 22.

People who receive Medicaid coverage report better overall health and less financial problems as a result of unpaid medical bills than individuals who don’t have insurance, a new bipartisan study has concluded. The report also undermines the GOP’s claim that people would be better off uninsured than on Medicaid, according to the researchers:

“What we found in a nutshell is that having Medicaid makes a big difference in people’s lives,” said Amy Finkelstein, another MIT economist and one of the study’s principal investigators.

Overall, researchers found that compared to people without insurance, those with Medicaid had better access to and used more health care; they were less likely to experience unpaid medical bills; they were more likely to report being in good health; and they were less likely to report feeling depressed.

In fact, says Finkelstein, among those with Medicaid, “We report almost a one-third increase in the probability that you report yourself as being happy.”

The report, which the National Bureau of Economic Research is publishing, found that the chance that a patient had a primary care doctor or facility was 70 percent higher among Medicaid enrollees. They received preventative care more frequently than the uninsured, with Medicaid-insured women 60 percent more likely to receive mammograms. Men and women were 20 percent more likely to get their cholestorol checked. And those with Medicaid were 25 percent more likely to say they had good health, and 40 percent less likely to say their health had worsened.

Beyond just taking care of their health, Medicaid coverage also helped to give patients financial security when it came to health care costs: Medicaid enrollees were 40 percent less likely to have to borrow money to pay medical bills, and were 25 percent less likely to have unpaid bills referred to collection agencies.

While the study may have only focused on Oregon’s program, these preliminary results already debunk some conservative claims against the program and reinforces how important Medicaid is for those who most need it.

A new analysis of poll data about the Affordable Care Act from 2009 to 2010 finds that public support for health reform may be higher and more consistent than previously thought. The study, published today in the newest issue of Health Affairs, shows that while support often depended on the wording of the question, on average, 57 percent of the public favored the public option, while overall support for the individual mandate averaged at 53 percent.

The study also found that despite the GOP’s best efforts to portray reform as a government takeover, the public showed consistent support for government programs. “When polling questions included phrases that described the public option as insurance, similar to Medicare, or available as an option or choice for consumers, support was higher—often considerably higher.” Even the “idea that the federal government should directly sponsor insurance—a major expansion of the government’s role—received strong support,” the researchers concluded:

In a phone interview with ThinkProgress Health, David Grande — one of the authors of the study and an assistant professor of medicine at the University of Pennsylvania in Philadelphia — pointed to the GOP’s (false) claim that the Paul Ryan budget protects traditional Medicare for current retirees as an indication of the fact that Republicans have not only poll tested their proposal but also learned from successes and failures of the health reform debate.

The GOP can complain about “burdensome” new Affordable Care Act regulations and standards, but it’s going to be hard to ignore the fact that some of these requirements are actually quite similar to a law signed by former governor and current 2012 presidential contender Jon Huntsman. Consider this admission from the head of Utah’s exchange, which was enacted as a result of Huntsman’s 2007 health reforms:

“We’ve already accomplished a lot that is required by the health law. If the law goes into effect and all the court cases have been heard, and we’re required to put those actions in place, we will certainly do that. We have moved through each phase of our process knowing that we would most likely have to do that. And a lot of what we want for Utah isn’t necessarily unlike what the federal requirements are, so we won’t likely have to unplug a lot of this.”

Many of the ACA rules surrounding exchange structure and minimum benefits requirements are still being drafted, but if the administration’s early statements are any indication, they will likely allow states like Utah — one of only two to already operate an exchange — to continue running the program with minimal changes. In other words, the administration is likely to err on the side of less federal regulation, heeding Jon Kingsdale’s advise. Kingsdale, who ran the Massachusetts exchanges, made the following recommendation at a recent Institute of Medicine panel: “My experience suggests revisiting and learning from cases and some flexibility and even phasing in would all be very helpful as you go down the path of defining a minimum benefit that will be extremely controversial,” he said. And if that’s the case, Utah will find itself already in compliance with many of the ACA’s new rues and the GOP argument that health reform represents some kind of big government overreach will look silly in the face of red state Utah’s similar model.

Yesterday, Louisiana Gov. Bobby Jindal (R) appeared at the First Baptist Church of West Monroe to sign HB 636, a measure that “requires women to be informed of their specific legal rights and options before they undergo an abortion procedure.” Abortion providers will now have to post signs around their facilities stating that “it is illegal to coerce a woman into getting an abortion, that the child’s father must provide child support, that certain agencies can assist them during and after the pregnancy and that adoptive parents can pay some of the medical costs.” The law also creates a Department of Health and Hospitals website and a mobile platform to deliver information “about public and private pregnancy resources” for avoiding abortions.

Jindal said he couldn’t understand why anyone would oppose the bill, comparing the new notices to Miranda warnings for women who receive abortions — a constitutionally protected procedure — to criminals:

“When officers arrest criminals today, they are read their rights,” he said. “Now if we’re giving criminals their basic rights and they have to be informed of those rights, it seems to me only common sense we would have to do the same thing for women before they make the choice about whether to get an abortion.”

The analogy, however, may be somewhat apt, since Louisiana already has some of the harshest anti-choice laws in the country. According to NARAL, the state still has an unconstitutional and unenforceable measure that prohibits abortion by anyone other than the woman unless necessary to preserve the woman’s life or if the pregnancy was the result of rape or incest. Louisiana outlaws second-trimester abortion procedure with no exception to protect a woman’s health and in 2006 “enacted a near-total ban on abortion, to become effective if the Supreme Court overturns Roe v. Wade.”

Under the state’s Right To Know law, abortion providers in Louisiana are already required to distribute pamphlets with information about pregnancy, termination, and alternatives. Women must also sign a statement that they have received the state information and are not being coerced into an abortion before undergoing the procedure.