Much of the benefit of the ACA for the lowest income individuals in our communities will be foregone if Utah chooses not to expand Medicaid, as individuals below the poverty line are ineligible for subsidized coverage in the health insurance exchanges. This will leave millions of people, including the working poor, without health coverage, creating a population that is "too poor for Obamacare."
As social workers, we have an ethical and professional responsibility to "advocate for changes to improve social conditions in order to meet basic human needs and promote social justice." At this time, there is no better way to fulfill this obligation than by advocating for implementation of the Medicaid expansion. There are currently 410,000 uninsured Utahns, and 253,188 Utahns currently enrolled in Medicaid. With expansion, those with Medicaid coverage would grow to 364,588. Of this expansion population, 30 percent to 40 percent will have mental health needs.
With expansion, most inmates would be eligible for Medicaid upon release from jail. There is significant evidence that ensuring that individuals have Medicaid coverage upon release from correctional facilities can contribute to reduced recidivism and create safer communities.
Medicaid expansion also will:
• Emphasize preventive care vs. high cost acute and higher level care.
• Emphasize community-based primary care physician care vs. expensive emergency room care.
• Create a more financially disciplined health care system.
• Result in a net deficit reduction, according to the Congressional Budget Office.
• Require that 80 - 85% of premiums must be spent on medical care or quality improvements.
• Create payments based on outcomes, preventing readmissions, etc.
• Provide insurance for more Utah citizens.
Utah must act now or risk losing millions of dollars designated to improve the health and well-being of our citizens. The federal money is already appropriated, but will be distributed to other states if Utah does not enact Medicaid expansion.
In addition to improving Utah's bottom line by limiting uncompensated care, Medicaid expansion will provide vital health care coverage to childless adults under the age of 65, as well as to uninsured families near the poverty line, making lifesaving health services, including mental health care, available to those who need it the most.
Emily W. Bleyl is executive director of the National Association of Social Workers, Utah Chapter, and Elise Hutchings is board president of the chapter.