Low-income Americans in the South, where states impose some of the nation’s most restrictive Medicaid eligibility requirements, are being forced to put off the medical care they need because they can’t afford it. According to a new study from the New England Journal of Medicine, the American adults who don’t qualify for Medicaid assistance in their states are simply forgoing care — an issue that Obamacare’s Medicaid expansion, which seeks to extend public health insurance to the low-income people who can’t currently qualify for it, can help address.

Obamacare’s expansion seeks to standardize Medicaid eligibility levels throughout the country, since there’s currently a huge range of different Medicaid eligibility rates across different states. Some states define Medicaid eligibility so narrowly that families of three making just $5,000 per year aren’t considered poor enough to access public health insurance. Researchers used county-level data to confirm — predictably — that the low-income people in those states are less likely to get medical care. The problem was the worst in Florida and Texas, which have the greatest prevalence of residents delaying their health care services:

As the map shows, the county-level prevalence of delayed care has huge ranges across the country. Just 6.5 percent of the people in Norfolk, MA, are putting off their medical treatment, compared to a staggering 40.6 percent of the people who live in Hidalgo, TX.

Those numbers are directly related to whether states are defining their Medicaid pools by Obamacare’s expanded definition, and allowing people with annual incomes up to 133 percent of the federal poverty line to access coverage. In states that have set their Medicaid eligibility levels at or above 133 percent of the federal poverty line, fewer people are delaying care. If every state accepted the health law’s expansion of the program, each Medicaid program would be set at that level, and the map above wouldn’t have nearly as much variation.
Read more

Former Florida Gov. Jeb Bush (R) appeared on MSNBC’s The Daily Rundown on Tuesday morning to discuss, among other things, a potential presidential run in 2016. And his future political aspirations are already forcing him to choose his words carefully. Even though Bush is an ardent opponent of Obamacare’s Medicaid expansion in private, he wouldn’t go on the record to oppose Gov. Rick Scott’s (R-FL) recent decision to extend health coverage to an estimated 1.3 million low-income Floridians.

Obamacare’s state-level Medicaid expansion is popular with the public, and an increasing number of GOP leaders — including Florida’s — are finally awakening to the reality that accepting federal funds to expand Medicaid is the right move for their constituents as well as for their state budgets. That shift is forcing anti-Obamacare politicians like Bush to mask their opposition to expansion. When host Chuck Todd asked Bush whether he agreed with Scott’s new position on Medicaid expansion, the former governor claimed he’s been too “busy” to form an opinion on the subject:

TODD: Did you think it was the right decision? Would you have made that call?

BUSH: Anytime you have a chance to advocate reform, you should. So Medicaid needs to be reformed. If you’re going to expand it by 50 percent, it sure better be a dramatically different system. And in Florida, there’s a waiver that has been approved that could be that reform — that expands on the reforms that I had a chance to advocate when I was governor. So if the focus is on making Medicaid work for people and that it won’t create this out year costs that people anticipate, that somehow the reform will yield a better result, then okay. Then give him credit. But I haven’t heard that yet –

TODD: You’re not there yet.

BUSH: I guess I’ve been busy, I haven’t been watching the specifics of it. If that’s the case, kudos to the governor. If it isn’t, then he’s put the state in a precarious position three or four years out.

It’s likely not a politically smart move for Florida’s former governor to publicly come out in opposition to extending health coverage to low-income residents in his state, which has one of the highest uninsurance rates in the nation. As of two weeks ago, however, Bush had made up his mind enough to privately pressure Florida lawmakers to oppose expanding Medicaid — urging them to stand in direct opposition to Rick Scott and come up with an alternative to expansion. Those efforts may have paid off. The state’s GOP-controlled House of Representatives voted to reject Medicaid expansion on Monday, effectively stalling reform.

Bush demurred on his personal position on Scott’s decision, but he did indicate his support for Florida’s Medicaid waiver — which is essentially a proposal to shift the program’s beneficiaries toward private managed care. If Bush does begin paying more attention to the specifics of health policy, he may be interested to learn that Florida’s push to privatize the public program would likely be even more expensive than accepting Obamacare’s traditional expansion, since Medicaid is currently much cheaper than private insurance.

The GOP’s potential presidential candidates are split on the issue of Medicaid expansion. New Jersey Gov. Chris Christie agreed to expand Medicaid just last week — a position that may have landed him in hot water with the conservative establishment — but Louisiana Gov. Bobby Jindal remains opposed it, and Wisconsin Gov. Scott Walker has rejected Obamacare’s Medicaid expansion in favor of a risky proposal that may end up providing his state’s poor residents with a lower quality of coverage.

Florida Gov. Rick Scott (R), a former hospital CEO and ardent Obamacare critic, announced at a press conference Wednesday evening that he will accept Obamacare funding in order to expand his state’s Medicaid program for low-income Americans. The move comes after Scott secured a waiver to privatize the public insurance program.

The decision represents a marked departure from Scott’s previously held stance. Scott didn’t just initially oppose taking part in the expansion — which the Supreme Court ruled to be optional last summer — he knowingly cited wildly inaccurate figures to inflate the program’s cost to the state by 2500 percent in an effort to discredit it. He eventually dropped his estimate for the expansion by $23 billion in the face of intense media scrutiny. The federal government will pay the lion’s share of funding for states that expand Medicaid, including fully funding expansions for the first three years.

Participating in the expansion will provide medical and financial security to about one million low-income Americans in Florida, a state that has one of the nation’s highest uninsurance rates. But some public health officials worry that Scott’s concurrent decision to privatize the state’s Medicaid program could leave poor Americans by the wayside. An initial pilot program for the privatization in five Florida counties was rife with collusive practices, dropped coverage, and profit-making at the expense of Floridians’ health — but Florida lawmakers claim that they have fixed the problems, citing “increased oversight and more stringent penalties, including fining providers up to $500,000 if they drop out.”

Scott’s decision comes after intense lobbying by Florida’s hospitals, who would benefit greatly from treating low-income Floridians with actual insurance as it would substantially lower their uncompensated care costs. “If Florida doesn’t expand Medicaid, we’re going to have the money taken out of one pocket, we just won’t get it put back in the other,” said Tommy Inzina, chief administrative officer at BayCare Health System.

But regardless of Scott’s motives, his actions could serve as a model for the 10 remaining GOP governors who have still not announced whether or not they will take part in Obamacare’s Medicaid expansion. To date, six other Republican governors — in Arizona, Michigan, New Mexico, North Dakota, Ohio, and Nevada — have decided to expand their Medicaid programs. Wisconsin’s Scott Walker recently announced his own alternative plan that, while better than nothing, will substantially limit the number of services and benefits that low-income Wisconsinites have access to.