The current Medicaid system at the state level provides insurance coverage for individuals adjusted based on income thresholds. The coverage system typically includes two to three providers partnered with the state, who cover individuals based on the region of the state where they reside. Outside of income requirements, Medicaid coverage can also extend to pregnant people, children, and the disabled through specialized state programs.
As detailed in the H.R. 3995 bill, its new proposed expansions to state Medicaid systems could broaden Medicaid coverage options to all people in the state, regardless of income level. A similar system is in place in Canada, where citizens are offered state-sponsored health insurance coverage regardless of income level. This system covers all eligible individuals in Canada through taxes, while states determine their health insurance plan’s coverage.
Introduction to H.R. 3995
H.R. 3995 hopes “to establish a State public option through Medicaid to provide Americans with the choice of a high-quality, low-cost health insurance plan.” It proposes to alter the current Medicaid system and require states to provide all citizens, regardless of income, age, pregnancy status, or disability status, with the option of an affordable, quality health insurance program managed by the state.
A similar bill was recently introduced in the Senate, indicating the importance of Medicaid expansion and signaling future support for the bills on the voting floor. Though many policymakers view these policies as effective in the long run, the debate surrounding federal influence on state Medicaid systems continues. Mixed opinions on federal involvement in state Medicaid programs have led to concerns over overreach and interference, with others citing the necessity of expanding health assistance programs.
Support for H.R. 3995
According to the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within the Department of Health and Human Services, access to Medicaid coverage is associated with improved health and lowered mortality in states. The full brief detailed the economic and health benefits of expanding Medicaid coverage at the state level due to those findings. Thus, this brief indicates that further expansion of Medicaid through H.R. 3995 would improve health and potentially lower mortality.
Furthermore, a 2018 study from the University of California, Los Angeles’ Fielding School of Public Health found that an estimated 20 million previously uninsured people have gained coverage through the Affordable Care Act and Medicaid expansion. This study tracked the Affordable Care Act’s impacts on access to health care and insurance for low-income populations. Since the previous Medicaid expansion was successful in providing insurance coverage to previously uninsured people, H.R. 3995 would likely mirror those successes.
When analyzing the current U.S. healthcare system, Forbes reports many people in both the economic and health sectors find the current mostly privatized U.S. health insurance system to be very expensive and inefficient for the average American. Data heavily supports this position and Medicaid expansion due to the potential improvements to the U.S. healthcare and insurance systems. As Medicaid currently only covers people below a certain income level, it might create an economically friendlier healthcare system to Americans. Outside the issues of expense and inefficiency, the privatized U.S. healthcare system has many gaps that prevent people from receiving timely and adequate care, which were exacerbated by the COVID-19 pandemic.
A final positive perspective on H.R. 3995 is that the language of the bill indicates that the proposed expansion would provide more options for healthcare at the state level. This means that no private options would be removed for this bill to take effect, and it would only provide a more affordable alternative to policies already available. In that way, the health insurance options at the state level would only be expanding.
Critiques of H.R. 3995
Outside of the benefits associated with Medicaid expansion, there are many issues with H.R. 3995 that would need to be addressed before this policy would be viable at the federal level. Even though 41 states have expanded Medicaid under the Affordable Care Act, the current Medicaid system has systemic problems and coverage gaps, potentially exacerbated by expanding the state programs. For example, current Medicaid patients have greater difficulty scheduling health care appointments compared with private insurance patients. This policy could also create new issues that would further strain the already fragmented system that faces challenges supporting itself on federal and state funding.
Due to recent policy decisions in the House and Senate cutting funding to Medicaid, the funds to expand or even maintain Medicaid may be in jeopardy, sufficiently undermining H.R. 3995’s feasibility. It remains to be seen whether H.R. 1 and other bills’ cuts to Medicaid will continue and its passing will impact H.R. 3995.
Internationally, other countries sponsoring state-funded health insurance programs that already exist have been noted for their long wait times and inadequate coverage for specialized procedures, such as in the Canadian system. If these issues are carried into the new system under H.R. 3995, this could further complicate the current privatized system and ultimately pave the way for a more broken hybrid system rather than a stronger one with more options.
Looking Ahead
The best way for policies that expand Medicaid coverage to move forward may be to alleviate the current issues in state-sponsored health insurance programs. Without considering these problems, the larger issues may fan out from an underdeveloped hybrid public and private health insurance system. As Medicaid expansion has been associated with improved health outcomes and reduced mortality, pathways such as this bill carry significant implications in further increasing state health delivery. If this bill reaches the implementation phase, the proposed expansions could be a positive change overall for the U.S. health insurance system. While the intended purpose of H.R. 3995 is to positively improve state health, detailed implementation is needed to aptly provide individuals with quality, affordable health insurance.