THURSDAY, March 22 (HealthDay News) -- The Medicaid program is
bracing for an expansion that will bring an estimated 16 million
more Americans into the health-care safety net, as required by the
Affordable Care Act.
But whether that happens depends on how the U.S. Supreme Court
rules on the legal challenges to the massive health-care reform
Twenty-six states are challenging the requirement to comply with
the new Medicaid eligibility rule or lose federal matching funds,
calling it coercive and a violation of states' rights. On March 28,
they will argue before the Supreme Court that that provision of the
Affordable Care Act is unconstitutional.
The Medicaid expansion opens eligibility to all people with
household incomes up to 133 percent of the federal poverty level --
whether unemployed or the so-called working poor -- starting in
January 2014. That translated into an annual income of
approximately $14,850 for an individual and $30,650 for a family of
four in 2012, according to the U.S. Department of Health and Human
Until now, the main groups of people served by the Medicaid
program have been low-income parents and children, the frail
elderly and the disabled.
The Medicaid expansion provision is considered more likely to
survive the legal challenge than the Affordable Care Act's most
controversial provision: the individual mandate, which requires
most adults to have health insurance or pay a fine.
"I don't think [the Medicaid expansion] is as vulnerable, but it isn't an entirely trivial issue. The basic point is that the [U.S. Supreme] court has been very clear for a very long time that Congress can require states to do things using Congress' spending power," said Renee M. Landers, a professor at Suffolk University Law School in Boston.
"The problem the challengers have in [arguing] that the [Medicaid expansion] is coercive is that the federal government is paying for 100 percent of the expansion for the first 10 years that the law is in effect," Landers said.
On Feb. 17, a group of 12 state attorneys general filed a brief
in support of the expansion's constitutionality.
"In a cooperative federalist program, the federal government establishes the program's core requirements and gives the states the freedom to implement their own programs within those requirements," an excerpt from the brief states.
At least five states are expanding their Medicaid programs
early: California, Connecticut, Minnesota, New Jersey and
Washington, along with Washington, D.C. Illinois is planning an
early expansion as well.
Will there be enough doctors to handle Medicaid patients?
Some physician groups are concerned about the effects of a
massive influx of enrollees into the already-strained Medicaid
Shortages of doctors already exist in specialties most likely to
work with Medicaid patients -- such as pediatricians and family
practitioners. And doctors say current Medicaid reimbursement rates
from government are too low to encourage more doctors to treat
"While expanding Medicaid access to more low-income Americans under the Affordable Care Act was an important step in the right direction, more progress is needed," said Dr. Peter Carmel, president of the American Medical Association. "Most physicians are currently unable to accept Medicaid patients due to low reimbursement rates, and this problem must be addressed as new patients enter the program."
One opponent of the Affordable Care Act said expansion of the
Medicaid program would hurt current enrollees by reducing access to
health-care providers and forcing longer waiting times -- without
helping the newly eligible.
"Medicaid may give them insurance cards -- good luck getting that care," said Grace-Marie Turner, president of the conservative Galen Institute.
Dr. Glen Stream, president of the American Academy of Family
Physicians, cited parts of the new law that, he said, should
attract and train more physicians in settings that serve Medicaid
"Components like teaching health centers are part of the Affordable Care Act," he said. "That's to take a federally qualified health center and do medical residency, medical education in that health center."
And he said a provision for student loan forgiveness could help
overcome a barrier to medical students choosing family medicine and
other primary-care specialties.
"It's important to acknowledge for our membership that [the new law] was controversial," Stream said. "We have 100,000 members across the country and certainly they represent the political diversity in our society.
"Our academy is focusing -- because the Affordable Care Act is now law -- on helping to preserve and expand and implement those pieces that we see as important to the health of people in our country," he added.
To learn about the Affordable Care Act and Medicaid eligibility,
To read an overview story on the Affordable Care Act,
For legal experts' best guess on how the Supreme Court will rule
on the Affordable Care Act,
To learn more about the importance of the individual mandate to
the Affordable Care Act,