Medicaid Expansion

Obamacare’s Next 5 Hurdles to Clear

Jun 26, 2015
nd White House Staff react to the House of Representatives passing the bill on March 21, 2010.
Pete Souza / White house

In its first five years, the Affordable Care Act has survived technical meltdowns, a presidential election, two Supreme Court challenges -- including one resolved Thursday -- and dozens of repeal efforts in Congress. But its long-term future still isn’t ensured. Here are five of the biggest hurdles left for the law.

What Health Law? Many Poor People Still Unaware Of Obamacare Options

Jun 11, 2015
A Kynect booth at the Kentucky Bourbon Festival in Bardestown, Ky., in 2013.
Phil Galewitz / KHN

Even in Kentucky, which championed the 2010 health care law by expanding Medicaid and running its own insurance marketplace, about half of poor people say they have heard little about the Affordable Care Act, according to a Harvard University study published Monday in Health Affairs.

Dallas's Parkland Hospital treats a lot of people without health insurance. On a November day in 1963, emergency room doctors at this county hospital frantically tried to save an American president who could not be saved. These days, emergency room doctors frantically try to treat 240,000 patients every year.

"So you can see we have every treatment area filled up. Beds are in the hallways and the rooms are all full," says Dr. John Pease, chief of emergency services.

Charla Douglas, who had a bad experience with TennCare, and her adoptive mother, Lynda Douglas in Hartsville, Tennessee
Jay Hancock / Kaiser Health News

Sweeping proposals disclosed Tuesday would create profit guidelines for private Medicaid plans as well as new standards for the plans’ doctor and hospital networks and rules to coordinate Medicaid insurance more closely with other coverage.

“We are taking steps to align how these programs work,” said Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, which proposed the rules.

Carrot and stick
Bruce Thomson via Flickr/ https://creativecommons.org/licenses/by-nc-sa/2.0/

Taking a cue from workplace wellness programs, Iowa and New Mexico are among more than a dozen states offering incentives to Medicaid beneficiaries to get them to make healthier decisions — and potentially save money for the state-federal health insurance program for the poor. The stakes are huge because Medicaid enrollees are more likely to engage in unhealthy practices, such as smoking, and are less likely to get preventive care, studies show.

Charla Douglas, who had a bad experience with TennCare, and her adoptive mother, Lynda Douglas in Hartsville, Tennessee
Jay Hancock / Kaiser Health News

HARTSVILLE, Tenn. — Lynda Douglas thought she had a deal with Tennessee. She would adopt and love a tiny, unwanted, profoundly disabled girl named Charla. The private insurance companies that run Tennessee’s Medicaid program would cover Charla’s health care. Douglas doesn’t think the state and its contractors have held up their end. In recent years she says she has fought battle after battle to secure essential care to control Charla’s seizures, protect her from choking and tube-feed and medicate her multiple times a day.

Johnny Reynolds knew that something was wrong as far back as 2003. That's when he first started experiencing extreme fatigue.

"It was like waking up every morning and just putting a person over my shoulders and walking around with them all day long," says Reynolds, 54, who lived in Ohio at the time.

In addition, Reynolds was constantly thirsty and drank so much water that he would urinate 20 or 30 times per day. "And overnight I would probably get up at least eight or nine times a night," he says.

While reporting on the rollout of the Affordable Care Act, journalist Steven Brill was diagnosed with a life-threatening condition that required heart surgery.

"There I was: a reporter who had made hospital presidents and hospital executives and health care executives and insurance executives sweat because I asked them all kinds of questions about their salaries and about their profit margins," Brill tells Fresh Air's Terry Gross. "And now I was lying on a gurney in a hospital in real fear of my life."

Tennessee's Medicaid Deal Dodges A Partisan Fight

Dec 29, 2014

Tony Smith's disability check puts him over the income limit to receive standard Medicaid, but it's too little for him to qualify for a subsidy.

Sitting next to a federal health-care navigator at a Nashville, Tenn., clinic, he said he hopes lawmakers think of his plight and that of thousands of others when considering Medicaid expansion.

"I'm not looking for a handout," Smith says. "I'm just looking for some help ... because I need it."

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