Medicaid is a state administered program that provides free and low cost health insurance to people with low income. Since its inception in 1935, funding for this insurance program comes from both the States themselves and reimbursements from the Federal government. The Federal share is higher in States that have a higher percentage of low income residents, but on average the Federal share has been around 60%.
The Affordable Care Act of 2010 (ACA) originally mandated that all 50 states would need to expand their Medicaid programs to include the nation's poor. As originally written, the ACA required Medicaid expansions in all State programs to include anyone who earned less than the U.S. Federal Poverty Level or lose their Federal reimbursements for their existing programs.
The ACA was passed by a Democrat Congress and signed into law by a Democrat President with no support from the conservative Republicans in the Congress. As part of a Republican strategy to cause the ACA to fail, a lawsuit was brought to the U.S. Supreme Court that claimed it was unconstitutionally coercive to force states to expand by threatening their funding.
Despite the fact that the States have been required to meet changing requirements (such as expanding Medicaid to include low income blind and disabled residents in 1980) to receive Federal reimbursements for their Medicaid programs since its inception, the Supreme Court decided that States should have the autonomy to decline Medicaid expansion.
Now over half of the states in this country have expanded their Medicaid programs to extend this benefit to the poorest of their residents. Nineteen states have chosen not to expand, even though the Federal government is paying all of the cost until 2016 and 90% of the cost through 2020 and beyond.
In the States which have not expanded, people who do not have access to health insurance are forced to seek charity care, mostly at hospital emergency rooms or at free clinics funded by donations and mostly administered by religious organizations.
In hospitals, the cost of charity care is passed on to other patients through cost shifting mechanisms which indirectly raise the cost o f health insurance for everyone else. At free clinics, donations that could be spent on other social problems such as housing for the homeless is instead being used to provide a minimal level of medical care. Neither of those options provide for anything but a basic level of care.
For those with no health insurance, there are no preventative screening to detect illnesses or diseases before they become chronically life threatening. For those people there are no subsidized medications. There are no referrals to specialists, no physical or recuperative therapy, no consultations to professionals who can help them make healthier lifestyle choices, and little if any mental health services.
The Constitution of the United States guarantees every citizen the right to life, to liberty and the ability to pursue happiness. This is the American dream, that most of us receive on a daily basis.
We, the insured, have access to health care that extends our lives, medications and treatments that cure our diseases, and support services that help us live happier lives.
We also pay the price... as a country, we spend the largest amount of money on health care per person in the entire world, yet as a whole our country ranks amongst the lowest in the tangible benefits that can be measured like life expectancy, infant mortality, obesity and preventable illness.
When someone can not afford health insurance, they have poorer overall health and significantly shortened life spans. They have a lower quality of life and face drastically limited care options if diagnosed with chronic or life threatening illness or disease.
In short, people with no health insurance die more often.
They become lives lost to a battle of political ideologies in the country that spends more on health care than any other country in the world.
As voters, we can change this. As an enlightened and compassionate people, I believe we must.
This book examines not only how we have gotten to this point, but also why. For far too long the poorest members of our nation have been forced to pay the price for our countries' political battles. The only way to change this course in the future is to understand the history that has brought us here.
I don't expect everyone who reads this book to agree with me that a liberal path for this country is better than a conservative one. This should be a nonpartisan issue, as both the left and the right should be working together to bring access to health care to every person, regardless of income, race, or social status.
I invite you to take the time to join me for a short history of health insurance in the U.S. so you can better understand how we have gotten here.
Let me explain to you why I think the reasons cited against Medicaid expansion are not just false, but deliberately misleading. Let us look together at the political battlefields in the expansion states, where partisan policies are being prioritized over people's lives.
Keep an open mind, and when we are done, make your own decisions and vote accordingly. If you read this book, I am betting that by the final page you will agree...
No More Lives Lost.