Health Care in Congressional District #2

by **Brian** Fri Jan 27, 2017 11:24 pm

Please check with Tina at tdcastanares@gmail.com for any corrections before quoting

Bullet Points for talking about Medicaid Expansion and the ACA with Congressman Walden

1. Almost 90,000 people in the 2nd Congressional District got onto Medicaid because of the ACA’s Medicaid Expansion Project. Congressman, make certain that any ‘reforms’ or replacements keep them, along with the other approx. 257,000 people on Medicaid in your district, on Medicaid – and that they don’t lose any of their current benefits, including preventive services, dental care and behavioral health care.
2. Replacing traditional Medicaid with block grants is an untested experiment which most analysts believe would reduce the number of Medicaid enrollees AND reduce the benefits (such as dental and behavioral health care) to those who still qualify. Remember, Congressman Walden, before the original Medicaid expansions that began in the 1990s in Oregon, the only people who qualified for Medicaid were under 56% of the federal poverty level. This was because the state couldn’t afford more. It took lots of reforms, federal permissions (“waivers”) and support --- most of all through the Affordable Care Act – to bring the uninsurance rate in Oregon to among the lowest in the nation, as it is today.
3. The Robert Wood Johnson Foundation has awarded the prestigious 2016 Culture of Health prize to the mid-Columbia region, i.e. in your district, and most of the elements it recognized had to do with Medicaid expansion and coordination. Don’t risk these remarkable accomplishments.
4. ENSURE CONTINUED FEDERAL SUPPORT OF MEDICAID EXPANSION AS PROMISED IN THE ACA.

by **Brian** Sat Jan 28, 2017 12:11 am

January 27, 2017 background and talking points ACA and Medicaid Expansion
Tina Castañares
As promised at the inaugural meeting of our Indivisible group Wednesday, I'm offering here some
background bullet points for making calls, writing letters, or preparing statements for Town Halls, etc.
regarding the Medicaid* Expansion element of the Affordable Care Act (ACA) (also known as
Obamacare), and the stakes and dangers in Congressman Walden's District if that Medicaid
expansion is rolled back.
__________________________
First, background for those who don't follow America's incredibly complicated health insurance
systems and what the ACA includes:
There are many elements in the ACA, and all are at risk from this administration and the
Republican-controlled Congress.
Among them are (not all-inclusive!):
--special funding of prevention and disease control services (more support of the Centers for
Disease Control, or CDC, and of public health entities across the nation);
--special funding of more Tribal (Native American/Indian) health services, also Veterans health
services, which I am no expert on;
--guaranteed funding of more preventive services for Medicare recipients* and for women’s and
men’s reproductive health;
--allowance of children up to the age of 26 being covered by their parents’ health insurance policies;
--creation of marketplaces/exchanges where people can buy commercial (“private”) health insurance
-- with subsidies and tax credits if they meet income criteria – without being excluded or penalized
for their health problems; (“Pre-existing conditions” exclusions disappeared under ACA.)
--requirement that most employers provide health insurance options to most of their employees, and
that individuals who don’t get health insurance through the workplace must buy their own (see
above) unless they’re eligible for public insurance (Medicare or Medicaid/Children’s Health
Insurance Program)* .
These provisions are complex and very American indeed, but given our systems, if they aren’t
preserved, other reforms are likely to collapse. It’s kind of a three-legged stool construction –
individual insurance, workplace insurance, and expanded public insurance, working together to
provide health insurance options for most people.
__________________________
Public insurance: Medicare, Medicaid
*Public insurance is basically Medicare and Medicaid, with some other programs for veterans,
certain federal employees, the Indian Health Services, and a few other categories.. (Medicaid
generally includes something called the Childrens’ Health Insurance Program.)
CAUTIONARY NOTE: Medicare is for adults 65 and over, and for certain people with
disabilities. Medicaid (which includes Oregon Health Plan, in the state of Oreogn) is for low-
income adults and children. When talking with officials, be sure you know that Medicare is
NOT Medicaid. They just have similar names.
MEDICAID EXPANSION UNDER THE ACA:
The Affordable Care Act offered states who opted to participate that the federal government
would pay almost 100% of costs for expanding Medicaid eligibility to low-income adults and children
under 138% of federal poverty level.
The federal monies would slowly reduce, but in 2020 would still cover about 90% of a state’s
costs for this expansion.
Oregon is one of the 31 states that chose to participate. This resulted in approximately
400,000 people being newly enrolled in Medicaid. In other words, the Medicaid Expansion
element of the Affordable Care Act enrolled 400,000 Oregonians in good health insurance!!
Here’s the 2 nd Congressional District which Congressman Walden represents (did you know it’s
geographically the largest in the nation?):

As you can see, nearly half of his constituents are on Medicaid. (Also fyi, 29,500 people got insurance from
the ACA marketplace/exchange.) The director of our Medicaid “Coordinated Care Organization” in the
Gorge believes that of this large number of people on Medicaid, almost 89,000 were added due to the
Medicaid Expansion of the ACA. This represents the largest increase to Medicaid of any Congressional
district in the nation, I am told.
FINAL BACKGROUND THOUGHTS
Congressman Walden has been reported to support continuation of the popular policies to keep
children up to 26 eligible for their parents’ health insurance, and to prevent a return to the bad old days
of “pre-existing condition” exclusions. Note that these are worthy goals, but they will mostly benefit the
middle class. Remember that MEDICAID IS ARGUABLY ABOUT THE MOST VULNERABLE OF ALL: LOW-
INCOME PEOPLE.
There is lots more to say to the Congressman and his staff about rollbacks of the ACA; for example,
economic impact (loss of jobs) could be tremendous. In fact, Oregon has been estimated to have the 5 th
highest adverse economic impact in the nation by several measures, including job loss, if ACA is
repealed and revoked.
The bullet points below, however, are just about the Medicaid Expansion element. I have not heard or
read any support by Congressman Walden for preserving Medicaid expansion, and most Republican
“reforms” being talked about include replacing the traditional Medicaid program, which has federal
dollars contributing to (smaller) state dollars, by a block-grant mechanism where the feds would give a
certain amount to each state and that state would have to ‘make do’ to establish qualifying criteria and
decide what services will be paid for, etc. Medicaid advocates and advocates of low-income people are
very worried about what that could mean --- many more people uninsured or underinsured, impact on
emergency rooms, people postponing getting vital care because of costs, all the old bad stuff.
Bullet Points for talking about Medicaid Expansion and the ACA with Congressman Walden
1. Almost 90,000 people in the 2 nd Congressional District got onto Medicaid because of the ACA’s
Medicaid Expansion Project. Congressman, make certain that any ‘reforms’ or replacements
keep them, along with the other approx. 257,000 people on Medicaid in your district, on
Medicaid – and that they don’t lose any of their current benefits, including preventive
services, dental care and behavioral health care.
2. Replacing traditional Medicaid with block grants is an untested experiment which most
analysts believe would reduce the number of Medicaid enrollees AND reduce the benefits
(such as dental and behavioral health care) to those who still qualify. Remember,
Congressman Walden, before the original Medicaid expansions that began in the 1990s in
Oregon, the only people who qualified for Medicaid were under 56% of the federal poverty
level. This was because the state couldn’t afford more. It took lots of reforms, federal
permissions (“waivers”) and support --- most of all through the Affordable Care Act – to bring
the uninsurance rate in Oregon to among the lowest in the nation, as it is today.
3. The Robert Wood Johnson Foundation has awarded the prestigious 2016 Culture of Health
prize to the mid-Columbia region, i.e. in your district, and most of the elements it recognized
had to do with Medicaid expansion and coordination. Don’t risk these remarkable
accomplishments.
4. ENSURE CONTINUED FEDERAL SUPPORT OF MEDICAID EXPANSION AS PROMISED IN THE ACA.

Health Care in Congressional District #2

Health Care in Congressional District #2

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