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Non-expansion of Medicaid creating ‘two Americas’ but hope abounds
ORLANDO — The current state of health care reform, in which some states are choosing to expand Medicaid and others are choosing not to do so, has split the country and is leaving many patients without coverage, according to an expert at the American Association of Diabetes Educators Annual Meeting.
“This is not a partisan issue. This is not an ideological issue. This is an issue of health and we have got to get these folks covered,” Jonathan Oberlander, PhD, professor of social medicine in the department of health policy and management at the University of North Carolina, Chapel Hill, said. “We’re developing two Americas. There is a gap between states who are expanding Medicaid and states that aren’t.”
Oberlander explained that although the Affordable Care Act tried to enact a nationwide expansion of Medicaid and a national standard of income eligibility, that aspect was struck down and, as such, states have the option of expansion but they are not required. He showed a map of those that are expanding and those that are not.
When coverage is not expanded, the poorest constituents are not eligible for subsidies that would assist them in buying health insurance, he said.
“It creates a huge inequity in coverage. ... The state of Florida and the state of North Carolina and the other states who have not expanded Medicaid are turning their backs on the most vulnerable people in their states. They are denying them coverage. They are turning away money that could help the state and, by the way, help the health care industry and hospitals in their states,” Oberlander said. “This is a moral issue. This is an economic issue.”
Another factor in this economic issue is controlling costs, he said, and patients with diabetes are expensive to treat even when they are being treated for something other than diabetes. He asked the audience to consider those patients with diabetes that they treat and consider how difficult their treatment would become without insurance coverage.
“When we create these groups of accountable care organizations and we give them incentives to hold down costs, diabetes is going to be at the center of this. Diabetes educators are going to be at the center of this. ... Diabetes is where the money is,” Oberlander said. “There’s going to be a lot of attention to figuring out how we reduce costs for these patients.”
Diabetes educators will play a role in this cost reduction, he said, and they will also play a large role in potentially making accountable care organizations successful by providing efficient, effective care for patients. So although the current state of the health care marketplace is not providing for all patients, Oberlander said he is very hopeful, possibly more hopeful than ever before.
“This problem of the uninsured is going to be with us for a long time,” he said. “This is a time of tremendous change in the system, tremendous uncertainty. ... You’re going to be part of that change and although there are lots of challenges ahead of us, lots of peril, there’s lots of promise, lots of opportunity. We have an opportunity to remake American medical care. We have an opportunity to make it more efficient. We have an opportunity to make sure that patients with diabetes get the care they need when they need it in a way that is quality medical care, and to prevent more people from getting diabetes. There’s lots of opportunity ahead of us.” — by Katrina Altersitz
For more information: Oberlander J. GS01. Presented at: The American Association of Diabetes Educators Annual Meeting 2014; August 6-9, 2014; Orlando, Fla.
Disclosure: Oberlander reports no relevant financial relationships.