The Debate about Health Care Reform Continues

Nothing has caused more debate in recent years than the issue of health care reform.  On March 23, 2010 President Obama signed the Affordable Care Act (colloquially known as Obamacare) into law.  Shortly after that, twenty-six states filed a multi-state law suit challenging the constitutionality of the Affordable Care Act.  The Supreme Court heard the case and ruled the Act constitutional on June 28, 2012.

The Affordable Care Act expands and standardizes the eligibility requirements  for Medicaid to 138% of the federal poverty guidelines.  Expansions in Medicaid are optional for states but the federal government incentivizes expansion by paying 100% of the cost for three years.  Because 65% of Pawnee Mental Health Services’ patient fees in FY2012 came from Medicaid, the future of the Medicaid program is of significant interest to the agency.

The Affordable Care Act also establishes insurance “exchanges” from which people can go online and purchase their health insurance. Each state is required to have its own exchange.  Exchanges can be state-run, a state-federal partnership, or federally run.The Affordable Care Act provides subsidies for people with incomes between 138-400% of the federal poverty guidelines who obtain their health insurance coverage through a state-run exchange.   An omission in the drafting of the law excludes mention of subsidies for people from states like Kansas which will have an exchange which is a state-federal partnership or federally run.  Since state grant funding for the uninsured has been cut by nearly 50% since FY2008, the issue of access to affordable health insurance for the uninsured is also of significant interest to the agency.

By Robbin Cole, Executive Director

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