So, when the Patient Protection and Affordable Care Act was passed, it had a Medicaid component.  It was left to the states to add that component as a benefit to their residents; if chosen, it would alter the way Medicaid reimbursement worked in that state.

Not surprisingly, many of the states that were led by the GOP elected NOT to extend the Medicaid benefits.  After all, the GOP spent a decade trying to repeal the PPACA (aka Obamacare) without ever having an alternative to offer their citizens.  But, that still dind’t mean these states would elect to add the Medicaid component.

This component provides health care coverage – at radically reduced rates (or free) to those citizens whose family income is but 133% (or less) of the federal poverty level.  These income levels range from $ 18K for an individual to about $ 37 K for a family of four.

 

Over the years, some of the states relented (and some had different political parties running their state).  And, some of the states were forced to add Medicaid services because the voters demanded same via propositions and initiatives.  (South Dakota is one of the more recent states to open up Medicaid to its residents- the seventh one to do so-  so that the poorer residents of the state could obtain useful health care coverage.)

As of now, only 11 states have precluded the Medicaid expansion for their residents.  (And, yes, there is a racial component to this- since a great number of those denied coverage are folks of color.)  While Florida, Mississippi, and Wyoming allow the initiatives, there has been no action to extend Medicaid coverage within these states. Eight of these 11 states (AL, GA, KS, NC, SC, TX, TN, WI) do not allow ballot initiatives, so the legislature would have to extend the coverage.

The residents from these states should strongly consider offering health care protection to their most needy citizens.

Moreover, there actually is a dialysis component, when Medicaid expansion is afforded to state residents.

As recently reported by Drs. KH Nguyen, R Thorsness, M Rivera-Hernandez, D Kim, S Swaminathan,, A Trivedi, and Y Lee (Brown University) and Dr. R Mehrotra (U Washington)  in an interesting study in JAMA Network.   The title of the article was “Medicaid Expansion and Medicare-Financed  Hospitalizations Among Adult Patients  with Incident Kidney Failure”.

First, a little background.  You already know (from reading my blog, of course) that dialysis is covered by Medicare, after an initial waiting period.  That waiting period, over the decades, has been extended to 18 months.  Which means many patients run into problems covering the high costs of dialysis after they initiate treatment.   (They need Part D coverage and cost-sharing- but still are stuck with high out-of-pocket costs.)

If these folks were covered by Medicaid, then those costs would not be an issue.  Nguyen’s study  provides that proof.

The research covered 188,871 adults (19 to 64 y of age), of which more than half (97,071) resided in Medicaid expansion states.  The study indicated that hospitalizations (an extra cost item, of course) are decreased by more than 4 days (4.24, to be exact) per 100 patient years during the first 3 months of their treatment. There are also fewer number of hospitalization events during the fist six months of dialysis onset, as seen in the graphs above.

How’s that for concrete evidence that Medicaid expansion not only provides better care for all citizens, but decreases out-of-pocket costs- and hospital usage.  (Especially since indigent care is not fully recovered by hospitals and clinics.)