TALLAHASSEE, Fla. – Un reporte reciente destaca las discrepancias económicas y en otras áreas, entre los estados que han expandido sus programas Medicaid, y los que no lo han hecho… Florida incluido.

Han pasado dos años desde el comienzo de la expansión de Medicaid, y este reporte señala que está siendo redituable para los estados que han ayudado a cerrar su “vacío de cobertura” mediante beneficios económicos para los sistemas de atención a la salud y para la gente a la que atienden. Pero Florida se los está perdiendo. Y es que más de medio millón de floridanos ni pueden pagar un seguro médico a precios de mercado, y ni califican para Medicaid. La investigación señala, como consecuencia, la presencia de un efecto dominó benéfico en la estabilidad del sistema estatal de salud.

Mark Pafford es Presidente del Consejo en Florida CHAIN, y líder de la minoría parlamentaria. Él ubica la culpa de esta falla en el fracaso de la Legislatura para actuar a favor de los hospitales, que tuvieron que recortar personal y reducir servicios.
 
“Hablo de proveedores que tratan con gente que necesita seguro de salud, que muchas veces está en la pobreza, que trabaja en empleos de tiempo completo, así que el impacto económico a estos hospitales es realmente injusto.”

De acuerdo al reporte del Centro de la Universidad Georgetown para los Niños y las Familias (Georgetown University Center for Children and Families), los hospitales y clínicas de Medicaid en los estados que sí lo expandieron, reportan apertura de nuevas instalaciones, compra de nuevo equipo y la contratación de personal. Hasta la fecha, 31 estados y el Distrito de Columbia han optado por expandir Medicaid.

Jack Hoadley, co-autor del reporte, afirma que los estados que ampliaron Medicaid ya han visto importantes reducciones en la cantidad de casos de atención brindada sin compensación por las instituciones de la red de salvación, caídas significativas del número de residentes no asegurados y ahorros en el presupuesto para hospitales y centros comunitarios de salud.
 
“Este es el tipo de efecto dominó. No es sólo que ahora el paciente llega y recibe atención, o que ahora viene y puede pagar por el servicio en vez de recibir un servicio de caridad, sino que los dólares ahorrados –o los dólares que son traídos a estas instituciones– realmente se usan de manera que cambian fundamentalmente la forma de brindar cuidados.”

Pafford agrega que encuentra irónico que el Gobernador Rick Scott haya tomado una postura tan dura contra la expansión de Medicaid, pero por otro lado pida más dinero al gobierno federal para ayudar a prevenir y para monitorear la expansión del virus Zika en Florida.

“Así que, en un momento en el que la capacidad estatal para responder debiera estar al máximo, le dio la espalda a la expansión de Meidcaid –que fue la entrega de ese dinero para reaccionar al Zika.”

Quienes se oponen a la expansión de Medicaid suelen decir que implica un mayor peso sobre los presupuestos del estado, pero el reporte encontró beneficios fiscales para muchos estados en expansión… desde 25 millones de dólares de ahorro en Kentucky, hasta 100 millones de dólares en el estado de Washington.

El Reporte (en inglés) está en ccf.georgetown.edu.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.

The California State Assembly is considering a bill to require schools to have a cardiac arrest response plan. Assembly Bill 2887 would make sure schools update their safety plans to include CPR training and an automatic external defibrillator or AED onsite.

Dr. Stephen Sanko, a professor of clinical emergency medicine at USC, and a founding member of the Cardiac Arrest Survivor Alliance, is a volunteer expert for the American Heart Association. He said having a plan in place is critical.

"The American Heart Association is promoting that schools have a cardiac arrest response plan. A written protocol for what to do in order to decrease the likelihood that if somebody collapses, that they die," he said.

Two years ago, 15-year-old Cash Hennessy collapsed on the football field due to a previously unknown heart defect. Two off-duty medics in the stands gave him CPR. The school brought out its AED - but it was useless, because the batteries were dead.

Hennessy said the experience was traumatic.

"I feel blessed that I had people there for me, that could give me C-P-R. But I think about if those people weren't there and that was another kid, who knows what would have happened? Because there wouldn't have been an AED to save them," he explained.

An AED walks people through the steps to deliver a life-saving shock to a person's heart until an ambulance arrives. Studies show that 70% of kids who suffer sudden cardiac arrest at school recover if an AED is deployed correctly - whereas the survival rate for kids and adults not in the hospital is less than 12%.