House Bill Expands Medicaid to 15M more Americans

Update, 11/10/09: I made an error in the # of Americans newly eligible for Medicaid via this bill.  It is 15M Americans; through Medicaid expansion, subsidies, and insurance exchange options, 36M Americans overall will be newly covered through this legislation.

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Congrats to House Speaker Pelosi, President Obama, the American people, and other elected leaders for their efforts to pass this historic healthcare bill. I'm always up for celebrating any social policy that is the next big victory since LBJ's achievements forty years ago.

Gay Rights blogger Mike Jones has some terrific info on one key Medicaid expansion in the bill that permits states "to cover early HIV treatment...a departure from a current policy that only allows states to use Medicaid funds once a patient develops full-blown AIDS." Let's take a look at the other wins for low-income Americans in the bill:

The WSJ describes the uninsured as "the biggest winners" in this bill due to subsidies to provide insurance for low- and moderate-income Americans, and the expansion of Medicaid to reach a wider range of poor households up to 150% of the federal poverty level. 36M additional Americans will now be eligible for Medicaid.

Another key provision in the bill now prevent insurers from denying enrollees based on pre-existing conditions, which makes a world of difference for households caring for special-needs, disabled and ill persons.  The threat of losing a job or changing jobs and the associated risks of insurance interruption and possible loss of coverage is eliminated here, reducing the current risk of households going bankrupt to cover medical bills.

Pelosi made some really disappointing and troubling concessions on abortion coverage to gain votes from conservative Democrats (more on this later), but one important victory for women is the elimination of gender disparities in health premiums.  For convoluted, institutionalized discriminatory reasons, women pay more on average than equivalent men, and are also denied on pre-existing conditions exclusive to women (such as having a c-section). Given women are at much greater risk for poverty and economic hardship in this country, any effort to reduce socio-economic disparities like this are tremendously important.

There's some question about how well this bill serves low-income children, and I'm going to look into that.  I'll also be reporting back on the abortion fight and what that means for poor women - this will no doubt be an on-going showdown in the Senate negotiations.  And let's not forget that: the Senate has to pass a bill, and conventional wisdom says this will happen.  But the Senate is more conservative than the House, and less beholden to public opinion, as we're seeing over and over again on this issue.  So there's reason to believe the final bill will be less generous to low-income Americans, esp. women.  Stay tuned.

For now, let's celebrate this important victory, it's ugly warts and all.

Special thanks to Rep. Anh "Joseph" Cao from Louisiana for voting for this bill. His district (LA-2) includes New Orleans, and despite being a religious Catholic and the first Vietnamese elected to represent the region, he did a good, and likely politically necessary, thing in supporting the bill.

(Photo of Speaker Pelosi and House Democratic leaders introducing America's Affordable Health Choice Act (HR 3962) in July 2009.  The bill passed yesterday as the Affordable Health Care for America Act by a vote of 220-215. Photo from Speaker Pelosi's Flickr photostream.)