Health ReformPolicy & Law

Delay of Care of Adults Closely Tied to Tighter Medicaid Eligibility Rules

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We all know the potential effects of the option of states which choose to forgo Medicaid expansion, given the choice to do so via last year’s SCOTUS ruling. On the brink of a flood of tens of millions of suddenly-insured Americans under the ACA, many states realize the economic feasibility in preparing for an onslaught of healthcare consumers with chronic diseases and the care delivery required to meet that demand.

We all know the potential effects of the option of states which choose to forgo Medicaid expansion, given the choice to do so via last year’s SCOTUS ruling. On the brink of a flood of tens of millions of suddenly-insured Americans under the ACA, many states realize the economic feasibility in preparing for an onslaught of healthcare consumers with chronic diseases and the care delivery required to meet that demand. In fact, some red- and purple-state holdouts (Arizona, Ohio, for example) have flipped on the issue, now supporting the move to expand the coverage. Florida governor Rick Scott most notably now embraces the action, probably because of political pressure on him to do so. Among the persistent holdouts, though, are states like Texas, whose governor Rick Perry remains steadfast in his decision to use federal funds for this ACA provision.


The consequence of withholding Medicaid benefits would undoubtedly have deleterious effects on the healthcare economy in a state which already leads the country in the overall number of its uninsured. Perhaps this is punctuated best in the data just released in this week’s issue of the NEJM. Researchers have found that the number of U.S. adults delaying care because of cost is highest in counties and regions in which Medicaid restrictions were the most oppressive. It should come as no surprise that the county that leads in the researchers’ demographic is in Texas.

[T]he county-level prevalence of delayed care ranged from 6.5% in Norfolk, Massachusetts, to 40.6% in Hidalgo, Texas. More restrictive Medicaid eligibility criteria were associated with a higher prevalence of delayed care than that observed when eligibility criteria were set at or above 133% of the federal poverty line.

Under the ACA, cutoff criteria (the economic floor) for eligibility for a family of four is 133 percent of the FPL. By extension, poor Hispanics were the demo most likely reflected in this data. Primary care physician penetration in these areas was also low. The article points to a “weak healthcare infrastructure” in the counties where the prevalence of those delaying care is extremely pervasive. States now have more latitude than ever in developing programs to deal with the increased access sure to occur with ongoing implementation of the ACA; hopefully, metrics such as those presented in this prevalence study can be used to improve upon that weakened infrastructure.

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