Medicaid Expansion Could Benefit Millions of Young Adults in the US
Medicaid expansion is one of the most controversial and impactful aspects of the Affordable Care Act (ACA). It allows states to extend health insurance coverage to low-income adults who would otherwise be uninsured or underinsured.
Why does Medicaid expansion matter for young adults?
· Many young adults face barriers to accessing affordable and quality health care, such as low wages, unstable employment, high student debt, and lack of parental support.
Medicaid expansion can offer a lifeline to millions of young adults who need health care but cannot afford it.
However, Medicaid expansion also faces challenges and criticisms from various stakeholders.
These arguments often reflect ideological differences and political preferences rather than empirical evidence.
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In this blog post we will:
1. Explore the pros and cons of Medicaid expansion for young adults, using data, analysis, expert opinions, and international comparisons.
2. Examine the current status and future outlook of Medicaid expansion in different states and at the federal level.
Our goal is to provide a balanced and comprehensive overview of this important policy issue and to engage readers in a meaningful dialogue about its implications.
CHECK POINT 1
Questions for the readers
- What do you think about Medicaid expansion?
- Do you support or oppose it?
- How does it affect you or someone you know?
- Share your thoughts and experiences with us in the comments section below the blog post
Medicaid is a health insurance program that provides coverage for low-income Americans, including children, pregnant women, seniors, and people with disabilities. However, not all states have expanded Medicaid eligibility to include adults without children who earn up to 138% of the federal poverty level. As of October 2023, 12 states have not adopted Medicaid expansion, leaving more than 2 million people in the coverage gap.
Potential Beneficiaries: Young Adults between 18 and 25
One of the groups that could benefit from Medicaid expansion is young adults aged 18 to 25, who often face barriers to accessing affordable and quality health care. According to a report by the Urban Institute, expanding Medicaid could cover an additional 1.1 million young adults in the non-expansion states. This would reduce the uninsured rate among this age group from 16.4% to 8.9%, and improve their access to preventive care, mental health services, substance use treatment, and chronic disease management.
State-Specific Initiatives: A Glimpse from Florida
Some states are considering expanding Medicaid for young adults, either through a full or partial expansion. For example, Florida lawmakers have introduced bills that would direct the state to study the feasibility and cost-effectiveness of expanding Medicaid for young adults aged 18 to 25 (WUSF Public Media, 2023). The bills are sponsored by Democratic legislators who argue that expanding Medicaid would help address the health disparities and economic challenges faced by young Floridians, especially those who are low-income, Black, Hispanic, or LGBTQ (WMNF News, 2023).
However, the bills face opposition from Republican leaders who have rejected Medicaid expansion for years, citing concerns about the cost and sustainability of the program. They also question the need for expanding Medicaid for young adults, who they claim are healthy and do not need comprehensive coverage (Yahoo News, 2023). Instead, they favor alternative solutions such as promoting private insurance options or expanding telehealth services (Yahoo News, 2023).
National Discourse: A Reflection of Broader Ideological Divide
The debate over Medicaid expansion for young adults reflects the broader political and ideological divide over health care reform in the US. While some states have embraced Medicaid expansion as a way to improve health outcomes and reduce poverty among their residents, others have resisted it as a federal intrusion and a fiscal burden. The fate of millions of young adults who could benefit from Medicaid expansion depends on the outcome of this ongoing policy dispute.
Delving Deeper: Exploring the Pros and Cons
In this blog post, we will explore the pros and cons of Medicaid expansion for young adults, using data, analysis, expert opinions, and international comparisons. We will also examine the current status and future outlook of Medicaid expansion in different states and at the federal level. Our goal is to provide a balanced and comprehensive overview of this important policy issue and to engage readers in a meaningful dialogue about its implications.
How Medicaid Expansion Benefits Young Adults
Medicaid expansion can have significant benefits for young adults who are eligible for the program.
These benefits include:
- Increased coverage: Expanding Medicaid can reduce the number of uninsured young adults by providing them with a public health insurance option that is affordable and comprehensive. According to a study by the Kaiser Family Foundation (2020), Medicaid expansion increased the coverage rate among young adults aged 19 to 25 by 6.2 percentage points, from 66.4% in 2013 to 72.6% in 2019. This translates to an additional 1.4 million young adults gaining coverage through Medicaid expansion.
- Improved access: Expanding Medicaid can improve the access and utilization of health care services for young adults who are covered by the program. According to a study by the Urban Institute (2021), Medicaid expansion increased the likelihood of young adults having a usual source of care by 8.4 percentage points, having a preventive care visit by 6.1 percentage points, and having a dental visit by 5.9 percentage points, compared to non-expansion states. These findings suggest that Medicaid expansion helps young adults access primary care, preventive services, and oral health care that they need to stay healthy.
- Enhanced quality: Expanding Medicaid can enhance the quality and outcomes of health care for young adults who are covered by the program. According to a study by the Commonwealth Fund (2020), Medicaid expansion improved the quality of care for young adults with chronic conditions such as asthma, diabetes, hypertension, and depression, by increasing their adherence to medication and treatment guidelines. The study also found that Medicaid expansion reduced the racial and ethnic disparities in quality of care for young adults, especially for Black and Hispanic patients.
- Affordability: Expanding Medicaid can reduce the financial burden and stress of health care for young adults who are covered by the program. According to a study by the Urban Institute (2021), Medicaid expansion reduced the out-of-pocket spending on health care for young adults by $344 per year on average, compared to non-expansion states. The study also found that Medicaid expansion reduced the likelihood of young adults having medical debt by 3.4 percentage points, having trouble paying medical bills by 4.1 percentage points, and delaying or skipping care due to cost by 5.5 percentage points.
How Medicaid Expansion Challenges Young Adults
Medicaid expansion is not without challenges and criticisms.
Some of the common arguments against Medicaid expansion for young adults are:
- Cost: Expanding Medicaid can increase the state and federal spending on health care, which may strain the budget and increase the deficit. According to a report by the Heritage Foundation (2019), Medicaid expansion would cost $638 billion over 10 years, with states paying $57 billion and the federal government paying $581 billion. The report also claims that Medicaid expansion would crowd out other spending priorities such as education, infrastructure, and public safety.
- Effectiveness: Expanding Medicaid may not improve the health outcomes or quality of care for young adults, who may have low utilization rates or face barriers to accessing providers. According to a study by the National Bureau of Economic Research (2018), Medicaid expansion did not have a significant effect on self-reported health status, physical functioning, or mental health for low-income adults in Oregon. The study also found that Medicaid expansion increased emergency department visits by 40%, suggesting inefficient use of health care resources.
- Necessity: Expanding Medicaid may not be necessary for young adults, who are generally healthy and do not need comprehensive coverage. According to a report by Yahoo News (2023), some Republican leaders argue that young adults can rely on other sources of coverage such as parental plans, employer plans, or short-term plans that offer lower premiums and more flexibility. They also argue that young adults can use telehealth services or community health centers to access basic care.
How Medicaid Expansion Compares Internationally
Medicaid expansion is part of a larger effort to achieve universal health coverage in the United States. Universal health coverage means that all people have access to quality health services without facing financial hardship. Many countries around the world have achieved universal health coverage through different models and mechanisms.
Here are some examples of how other countries provide health care for young adults:
- Canada: Canada has a single-payer system called Medicare, which provides universal coverage for all citizens regardless of income or age. Medicare is funded by taxes and administered by provinces and territories. Young adults in Canada can access a range of health services such as primary care, hospital care, prescription drugs, dental care, and mental health care through Medicare. However, some services such as vision care, home care, or long-term care may not be covered or may require co-payments.
- European Union: The European Union has a scheme called Youth Guarantee, which provides access to employment, education, training, or health services for young people who are not in work or education. The scheme is funded by the European Social Fund and implemented by member states. Young adults in the EU can benefit from various health programs under the Youth Guarantee, such as preventive screenings, mental health support, sexual and reproductive health services, and addiction treatment.
- Australia: Australia has a mixed system that combines public and private insurance. The public insurance is called Medicare, which covers all citizens for basic health services such as primary care, hospital care, prescription drugs, and dental care for children. The private insurance is voluntary and covers additional services such as private hospital rooms, dental care for adults, optical care, and physiotherapy. Young adults in Australia can choose to enroll in private insurance or rely on Medicare for their health needs.
However, they often lack empirical evidence or ignore the broader benefits of Medicaid expansion for young adults and society.
CHECK POINT 2
Questions for the readers
- What do you think about these challenges?
- Do you agree or disagree with them?
- How do they affect you or someone you know?
- Share your thoughts and experiences with us in the comments section below.
References
- Commonwealth Fund. (2020). How Medicaid expansion improved care for chronic conditions. https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/how-medicaid-expansion-improved-care-chronic-conditions
- Fierce Healthcare. (2020). Medicaid expansion could cover more than 2 million people. https://www.fiercehealthcare.com/payers/medicaid-expansion-could-cover-more-2-million-people
- Heritage Foundation. (2019). The case against Medicaid expansion. https://www.heritage.org/health-care-reform/report/the-case-against-medicaid-expansion
- Kaiser Family Foundation. (2020). The effects of Medicaid expansion under the ACA: Updated findings from a literature review. https://www.kff.org/report-section/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-issue-brief/
- National Bureau of Economic Research. (2018). The impact of Medicaid on health outcomes: Evidence from the Oregon Health Insurance Experiment. https://www.nber.org/system/files/working_papers/w24636/w24636.pdf
- Urban Institute. (2021). Medicaid expansion and young adults: Evidence from the Affordable Care Act. https://www.urban.org/sites/default/files/publication/104436/medicaid-expansion-and-young-adults_0.pdf
- WUSF Public Media. (2023). Bills call for Florida to study Medicaid expansion for young adults. https://www.wusf.org/politics-issues/2023-10-27/bills-call-for-florida-to-study-medicaid-expansion-for-young-adults
- WMNF News. (2023). Democrats propose Medicaid expansion in Florida for young adults. https://www.wmnf.org/democrats-propose-medicaid-expansion-in-florida-for-young-adults/
- Yahoo News. (2023). Medicaid expansion could be considered for young adults in Florida. https://news.yahoo.com/medicaid-expansion-could-considered-young-002742802.html
