RICHMOND, Va. - A comparison between states shows those that have expanded Medicaid are likely to have a healthier workforce. The Virginia General Assembly has so far refused to close what's known as the coverage gap, which mostly affects the working poor.
But a new study by the group Families USA finds states that have extended Medicaid under the Affordable Care Act have seen about twice the reduction in working people without health insurance. Kentucky saw one of the largest drops.
Cara Stewart, health law fellow at the Kentucky Equal Justice Center, says a healthier and more productive workforce has been one result.
"Kentucky saw reductions in smoking rates, saw reductions in obesity, we saw reductions in cancer deaths," says Stewart. "If you're getting treated for cardiovascular diseases, reducing your rates of smoking, then you're going to have healthier workers."
But opponents of Medicaid expansion have criticized it as a growth in government healthcare, charging the state may not be able to afford it long-term.
More than a third of Kentucky's uninsured working population has now gotten coverage. By comparison, 16 percent of the same population in Virginia got insurance though healthcare reform.
Dr. Richard Briggs is a heart surgeon and a Republican state senator in Tennessee, another non-expansion state. Briggs is frustrated that uninsured patients at his hospital who receive heart stents sometimes can't afford the medicine to keep them from clogging and every two weeks or so, one of these patients come back.
"In the middle of the night, through the emergency room, they're having a massive heart attack," he says. "The stent has clotted off. We end up taking them for emergency surgery. They come back. They've run up a huge bill, and they may never go back to work."
The Commonwealth Institute says more than 200,000 adult Virginians below the federal poverty line fall into the coverage gap. They make too much to qualify under current Medicaid rules, but not enough to get subsidized insurance though the healthcare exchange.
The Affordable Care Act intended to cover them through broadening Medicaid, with the federal government picking up almost all of the cost. But the Supreme Court ruled states could turn down that option
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Summer will be here before you know it, and experts say now is the time to get prepared for Arizona's scorching and life-threatening temperatures.
Some 645 heat-associated deaths were confirmed by Maricopa County's Department of Public Health in 2023, breaking the previous year's record by more than 50%.
Dr. Rebecca Sunenshine, the health department's medical director, said the 2023 Heat Related Deaths Report demonstrates this is a significant public health concern for Arizona's most populous county.
"This is really a call to action," she said, "to make sure that we all come together across the county - community-based organizations, cities, the county government - to prevent these deaths almost all of which are preventable."
In 2023, an average of 13 heat related deaths per day occurred during July, with people who were unhoused making up the largest proportion. With hotter months on the way, Sunenshine encouraged Arizonans to check on neighbors and seniors who may live alone, make sure air conditioning systems are working and follow the county's "10 tips" to stay safe in the heat.
In addition to tracking heat-related deaths, the Department of Public Health also conducted an evaluation of cooling and respite centers that were part of Maricopa County's Heat Relief Network last year. Sunenshine said they learned valuable details - including that two-thirds of respondents didn't have a stable home, and that many people found the cooling centers only through roadside signs advertising them.
"Some of the biggest barriers to accessing cooling centers are not knowing they exist, not knowing where they're located and not having transportation," she said, "and we based all our actions this upcoming summer on the results of this cooling center evaluation."
She said they were able to establish a call center, operated by bilingual community health workers, to help connect people not only to heat-relief resources but to energy and security-assistance programs.
Arizonans can call 211 to help find transportation to the nearest heat-relief location, when they open again on May 1.
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This week, an Alabama group is drawing attention to the need for Medicaid expansion.
Currently, approximately 300,000 people are stuck in a health care coverage gap, earning too much for Medicaid but not enough for private insurance.
Debbie Smith, Cover Alabama campaign director for Alabama Arise, said they are reaching out to legislators statewide and sharing information about the stakes involved.
"About 19 of our rural hospitals are at risk of immediate closure," Smith reported. "That means they are at risk of closing in the next year. And having patients that come in that don't have health insurance coverage is not good for their bottom lines."
The Cover Alabama Coalition is engaging lawmakers through meetings in their districts and encouraging residents to share their experiences and thoughts on Medicaid expansion via social media. Although 19 rural hospitals are due for immediate closure, a report on rural hospitals from advisory firm Chartis highlighted more could be at risk in the long run. The report revealed nearly 74% of Alabama's rural hospitals are operating at a loss.
Smith sees Medicaid expansion as a life-or-death matter, which can greatly enhance the quality of life for many residents. She noted it would provide access to preventive care and vital medications, and can help people enter or remain in the workforce. She pointed out the current Medicaid threshold creates barriers for families in need.
"Let's say a single mom with two kids, she can't make more than $4,656 a year and still qualify for Medicaid unless she has a disability or is pregnant," Smith observed. "And at the other end of the perspective, they have to make at least around $25,000 to qualify for the health insurance marketplace."
She added the expansion could also benefit around 5,000 veterans who lack coverage. Currently, 41 states including District of Columbia, have already expanded Medicaid. Mississippi has also recently passed legislation in its House, it is now waiting for a Senate vote.
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On Tuesday, Care4All California, a coalition fighting for affordable health care, unveiled a package of bills its members say they would like state lawmakers to pass.
Assembly Bill 3129 would give the California Attorney General the power to accept, reject or modify health care transactions involving private equity or hedge funds.
Asm. Jim Wood, D-Healdsburg, Assembly Speaker Pro Tempore and author of the bill, said mergers often improve the corporate bottom line but lead to higher prices for patients.
"We're often led to believe these consolidations will save money, that it's good for consumers," Wood observed. "But what we're actually seeing in health care is just the opposite, and it reduces competition."
Opponents said the bill would give government officials too much power. Care4All California also endorsed bills to help the state enforce requirements around implicit bias training for women's health providers in an attempt to make sure patient complaints are taken seriously and to reduce the number of people of color who die from pregnancy complications.
Asm. Laura Friedman, D-Glendale, is behind Assembly Bill 2297, which she said aims to make sure people do not lose their homes due to medical debt.
"A loophole allows debt collectors to place liens on patients' homes to collect unpaid medical debt," Friedman pointed out. "AB 2297 closes that loophole, and prohibits liens on property when collecting medical debt from financially qualified patients."
Another bill in the package would allow a 12-month grace period to cover people who qualify for Medi-Cal but were kicked off due to an administrative issue.
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