ACA Medicaid Expansion—Why did some States Opt-Out?

ObamaCare Medicaid Expansion was one of the biggest milestones in health care reform. ObamaCare’s Medicaid expansion expanded Medicaid to our nations poorest in order cover nearly half of uninsured Americans. The law previously required states to cover their poorest or lose federal funding to Medicaid (federal funding covers 90-100% of state costs) until the supreme court ruling on ObamaCare.  After the ruling, states could opt-out of the ACA Medicaid Expansion, and as Republican-led states did, it left millions of poor working families without coverage.

Under the ACA (Affordable Care Act, e.g., Obamacare), a new national Medicaid income eligibility level was established at 138% of the Federal Poverty Line.  (That 138% amount is about $15,400/year for an individual; $32,000/year for a family of 4.)  States that opted out of the ACA Medicaid expansion are projected to drive up insurance costs drastically in their states, potentially drive hospitals out of business, and save relatively little, if anything at all.

The ACA Medicaid expansion attempted to bring some uniformity across the nation to how Medicaid is administered.  Prior to 2013, every State had different eligibility requirements based on income, age, gender, dependents, and other state-specific requirements.  Starting in 2014, all states that expanded Medicaid have uniform eligibility requirements.  Those that did not, still have their previous requirements, and left millions of poverty-ridden people without effective healthcare options.

Read more about the ACA Medicaid Expansion here.

On a side note:

Today in the House of Representatives,219 Republicans voted to pass Rep. Paul Ryan’s “Path to Poverty” budget that would REPEAL the Affordable Care Act and turn Medicaid into a block grant to States.  Please note that a “block grant” is a large sum of money granted by the US Government to various State Governments, with only general provisions as to the way that money is to be spent.  It’s very easy to re-task that money into a slush fund with which to pay for other pet and ideological projects at the expense of those in desperate need.

Fact Sheet: The President’s Plan for Pre-K Education for All

The President’s Commitment to Early Education

A zip code should never predetermine the quality of any child’s educational opportunities.  Yet studies show that children from low-income families are less likely to have access to high-quality early education, and less likely to enter school prepared for success.  By third grade, children from low-income families who are not reading at grade level are six times less likely to graduate from high school than students who are proficient.  Often, the high costs of private preschool and lack of public programs also narrow options for middle-class families.

High-quality early childhood education provides the foundation for all children’s success in school and helps to reduce achievement gaps.  Despite the individual and economic benefits of early education, our nation has lagged in its commitment to ensuring the provision of high quality public preschool in our children’s earliest years. The Organization of Economic Cooperation and Development (OECD) estimates that the United States ranks 28th out of 38 countries for the share of four-year olds enrolled in early childhood education.  And fewer than 3 in 10 four-year olds are enrolled in high-quality programs.

Preschool for All

  • The President’s proposal will improve quality and expand access to preschool, through a cost sharing partnership with all 50 states, to extend federal funds to expand high-quality public preschool to reach all low- and moderate-income four-year olds from families at or below 200% of poverty.  The U.S. Department of Education will allocate dollars to states based their share of four-year olds from low- and moderate-income families and funds would be distributed to local school districts and other partner providers to implement the program.  The proposal would include an incentive for states to broaden participation in their public preschool program for additional middle-class families, which states may choose to reach and serve in a variety of ways, such as a sliding-scale arrangement.
  • Funds will support states as they ensure that children are enrolled in high-quality programs.   In order to access federal funding, states would be required to meet quality benchmarks that are linked to better outcomes for children, which include:
    • State-level standards for early learning;
    • Qualified teachers for all preschool classrooms; and
    • A plan to implement comprehensive data and assessment systems.
  • Preschool programs across the states would meet common and consistent standards for quality across all programs, including:
    • Well-trained teachers, who are paid comparably to K-12 staff;
    • Small class sizes and low adult to child ratios;
    • A rigorous curriculum;
    • Comprehensive health and related services; and
    • Effective evaluation and review of programs.
  • The proposal also encourages states to expand the availability of full-day kindergarten.  Only 6 out of 10 of America’s kindergarten students have access to a full day of learning.  In order to ensure that our kindergartners spend the time they need in school to reach rigorous benchmarks and standards, funds under this program may also be used to expand full-day kindergarten once states have provided preschool education to low- and moderate-income four year-olds.
  • Under the President’s proposal, investment in the federal Head Start program will continue to grow.  The President’s plan will maintain and build on current Head Start investments, to support a greater share of infants, toddlers, and three-year olds in America’s Head Start centers, while state preschool settings will serve a greater share of four-year olds.

Quality Early Learning for Our Youngest Children 

  • The President will also launch a new Early Head Start-Child Care Partnership program, to support states and communities that expand the availability of Early Head Start and child care providers that can meet the highest standards of quality for infants and toddlers, serving children from birth through age 3.  Funds will be awarded through Early Head Start on a competitive basis to enhance and support early learning settings; provide new, full-day, comprehensive services that meet the needs of working families; and prepare children for the transition into preschool.  This strategy – combined with an expansion of publicly funded preschool education for four-year olds – will ensure a cohesive and well-aligned system of early learning for children from birth to age five.
  • The President is proposing to expand the Administration’s evidence-based home visiting initiative, through which states are implementing voluntary programs that provide nurses, social workers, and other professionals to meet with at-risk families in their homes and connect them to assistance that impacts a child’s health, development, and ability to learn. These programs have been critical in improving maternal and child health outcomes in the early years, leaving long-lasting, positive impacts on parenting skills; children’s cognitive, language, and social-emotional development; and school readiness. This will help ensure that our most vulnerable Americans are on track from birth, and that later educational investments rest upon a strong foundation.