“Mr. Frodo Look: It’s an Oliphant” – Part 2


“The number of Americans without health insurance climbed to 27.5 million in 2018, according to Federal Data that shows the first year to year increase in a decade (and since the advent of the ACA).”[1]

Seema Verma, administrator for th CMS  blamed the long predicted and finally occurring increase in uninsured Americans in a decade on the Affordable Care Act. We discussed previously her unsubstantiated claim that the reason for the tick up in the uninsured was higher premiums under the ACA law which had higher-income people losing coverage because they couldn’t afford the premiums and didn’t quality for a subsidy.  A self imposed condition created by an Oliphant.

As I mentioned in the previous blog, it was the adminstration’s own executive order which created this pool of possible suspects as the culprits behind the increase in the number of people uninsured. But the data does not support Ms. Verma’s comments. Nor do they support her vigorous denial of the most likely source of the newly uninsured. Those eligible for Medicaid.

Let us start with the exact figures. The number of Americans without health insurance climbed to 27.5 million in 2018 (8.5%). This was up from the 25.6 million (7.9%) in 2017. “The uninsured rate in 2018 rose by 0.6 percentage point in states that expanded Medicaid, to 3.5%, for people living at or above 400% of poverty, or about $80,000 for a family of three, according to the census data. It rose 1.7 percentage points to 6.2% in states that didn’t expand Medicaid for this group.”[2]

Let us wind back the clock and look at what actually happened.


“As the economy continues to slowly improve, people’s incomes were maybe going up a bit and that was enough to pull them out of Medicaid but not enough for job-based coverage,” said Dr. Rachel Garfield, a vice president at the nonprofit Kaiser Family Foundation.[3]  In States that do not expand Medicaid, many adults fall into a ‘coverage gap’ of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits.

umbrella graphic

Here is some additional data on Medicaid.

 who is on medicaid chart

Refusal to take ACA’s Medicaid expansion

The ACA, which mostly went into effect in early 2014, reduced the number of uninsured in large part through the expansion of Medicaid, the federal-state program for low-income and unemployed people. Enrollment in the program rose by 14.7 million people between 2013 and 2019, with most of the increase coming in states that expanded the program. Several Republican-led states haven’t expanded their Medicaid eligibility.


Provided “health insurance to 74 million low-income and disabled people” with thirty-two ‘States’ (including Washington D.C.) participating.


States including Idaho, Utah, Nebraska, and North Carolina are weighing expanding their programs. Debate has also played a central role in the 2018 midterm contests in Florida, Georgia, and Kansas. The Virginia General Assembly “approved expansion of Medicaid.” In Maine-the Republican Governor refused to endorse this legislative initiative even after Maine voters voted overwhelmingly to approve Medicaid expansion.

One-third of the states continue to refuse federal funding to expand Medicaid. Medicaid expansion allows adults with income up to 138 percent of the poverty level to enroll in Medicaid. In states that have not expanded Medicaid, however, the state’s regular eligibility guidelines apply, and generally prevent able-bodied childless adults from enrolling, regardless of how low their income is.[4]

Medicaid Be Converted to a Block-Grant Program

“A block grant scheme would be very different from Medicaid’s statutorily required open-ended funding. Caps on spending could be designed in a number of ways, such as a block grant under which states would receive a limited, pre-budgeted amount of money from the federal government, or a per capita cap, which would pre-determine the amount of money spent per person enrolled in Medicaid.”[5]

Block Grants are predictably harmful to both beneficiaries and to state economic interests. The Congressional Budget Office has recognized that block grants encourage states to take actions that include restricting enrollment for legally eligible beneficiaries, limiting mandatory and optional benefits, decreasing already low reimbursement rates (which may lead providers to abandon the program), a combination of all three, and more.[6] [7]

impact of healthcare reform chart

The number of Americans without health insurance climbed to 27.5 million in 2018 (8.5%).  And which segments of our population are most likely to be impacted and join the ranks of the uninsured?


The ACA contributed to a spike in health insurance coverage for veterans. A bump in uninsured veterans is predicted if the ACA is repealed. There are 20 million veterans in the United States (VA, and Census).

510,000 (5.5 %) are non-elderly veterans (under 65), who are uninsured. Only 3 out of 5 non-elderly veterans are eligible for Veteran Affairs health care. Many veterans turn to Medicaid under the Affordable Care Act.  Some also rely on both Medicaid and the VA system

DISABLED[9] [10]

Some 42,097,860 (from 76,653 in Wyoming to 4.3 million in California) people with disabilities live in this country.  Of these, 15,164,958 currently have their health insurance through Medicaid. Of that total, three states (California with 1.9 million or 44.2%, New York with 1.1 million or 45.7%, and Texas with 1.03 million or 31.5%) have over one million disabled residence. Some 36% of the disabled individuals who currently have Medicaid coverage, become at risk to lose that coverage. The fifty-three percent of the disabled 40,102 in Washington D.C. is the largest at-risk pool.  Eight states have 40% or more of their disabled population at risk. The others have a range of 24% to 38%.


[1] Armour, Stephanie, “Number of Uninsured Americans Rises for First Time in Decade: Increase is largely driven by a decline in coverage under public programs such as Medicaid,” WSJ 10 Sep 2019, www.wsj.com/articles/number-of-americans-without-insurance-shows-first-increase-since2008-11568128381

[2] Ibid

[3] Garfield, Rachel, et al. “The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid.” The Henry J. Kaiser Family Foundation, The Henry J. Kaiser Family Foundation, 13 June 2018, www.kff.org/uninsured/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/.

[4] Norris, Louise, “10 ways the GOP sabotaged Obamacare: Trump and Congressional Republicans have spent years working to undermine the ACA,” Healthinurance.org, 17 May 2017, www.healthinsurance.org/blog/2017/05/17/10-ways-the-gop-sabotaged-obamacare/

[5] Sachs, Rachel and N. Huberfeld, “The Problematic Law And Policy Of Medicaid Block Grants,” Health Affairs, 24 July 2019, www.healthaffairs.org/do/10.1377/hblog20190722.62519/full/

[6] Congressional Budget Office, “Options for Reducing the Deficit,” Establish Caps on Federal Spending for Medicaid, 13 Dec 2018, www.cbo.gov/budget-options/2018/54726

[7] E. Salzman and C. Eibner, “Donald Trump’s Health Care Reform Proposals: Anticipated Effects on Insurance Coverage, Out of Pocket Costs, and the Federal Deficit,” The Commonwealth Fund Sep 2016, https://www.commonwealthfund.org/publications/issue-briefs/2016/sep/donald-trumps-health-care-reform-proposals-anticipated-effects

[8] Jessica Mathews, “America’s veterans: Caught in the middle of the GOP Obamacare repeal effort,” CNBC Modern medicine, 10 Nov 2017, www.cnbc.com/2017/11/10/americas-veterans-casualties-of-gop-obamacare-repeal-effort.html

[9] Julie Reiskin. “People with disabilities will pay for the GOP’s Medicaid cuts,” The Hill 21 Jun 2017, thehill.com/blogs/pundits-blog/healthcare/338800-the-disabled-will-pay-for-the-gops-medicaid-cuts

[10] Odum, Jackie et al, “The Impact of Medicaid Cuts on People with Disabilities: State-by-State Breakdown,” Center For American Progress, 22 Mar 2017, www.americanprogress.org/issues/poverty/news/2017/03/22/428185/impact-medicaid-cuts-people-disabilities-state-state-breakdown/

By | 2019-11-05T12:50:58+00:00 February 11th, 2020|Categories: Healthcare|0 Comments

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