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Affordable Care Act:  Medicaid Expansion Affordable Care Act:  Medicaid Expansion

Affordable Care Act: Medicaid Expansion - PowerPoint Presentation

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Affordable Care Act: Medicaid Expansion - PPT Presentation

Medicaid Expansion I NFIB v Sebelius Constitutionality of Medicaid Expansion under the Affordable Care Act Constitutionality of Expansion Supreme Court holds in NFIB v Sebelius Medicaid expansion violates Congress spending power as unconstitutionally coercive of states beca ID: 622641

medicaid expansion tenncare effects expansion medicaid effects tenncare future states eligible establishment tennessee fpl constitutionality 100 federal state supreme act financial present

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Presentation Transcript

Slide1

Affordable Care Act: Medicaid ExpansionSlide2

Medicaid Expansion

I.

NFIB v. Sebelius

: Constitutionality of Medicaid Expansion under the Affordable Care Act

Slide3

Constitutionality of Expansion

Supreme Court holds in

NFIB v. Sebelius

:

Medicaid expansion violates Congress’ spending power as unconstitutionally coercive of states because:

1. States not given adequate

notice to voluntarily consent to

expansion,

and

2. HSS Secretary could potentially withhold all of a state’s existing federal Medicaid funds for non-complianceSlide4

Constitutionality of Expansion

Medicaid Expansion is a

“gun to the head”

because the “threatened loss of over 10 percent of a state’s overall budget….is economic dragooning that leaves the states with

no real option but to acquiesce

.”

-

Sebelius

, at 54. Slide5

Constitutionality of Expansion

Coercive But.........

Supreme Court fashions a

“remedy”

to overcome the coercionSlide6

Constitutionality of Expansion

Supreme Court’s remedy for coercion:

Remedy is to limit HHS Secretary’s power to withhold existing federal Medicaid funds for state non-compliance with Medicaid expansion

Makes Medicaid expansion optional for statesSlide7

Supreme Court on ACA’s Medicaid Expansion

Issue

Vote

Support

Oppose

The ACA’s Medicaid Expansion

is Unconstitutionally Coercive

7:2

Roberts, Breyer, Kagan,

Scalia, Kennedy, Thomas, Alito

Ginsburg, Sotomayor

The Secretary’s enforcement authority should

be limited

5:4

Roberts, Breyer, Kagan,

Ginsburg, Sotomayor

N/A

The entire ACA should be invalidated

4:5

Scalia,

Kennedy, Thomas, Alito

Roberts, Breyer, Kagan,

Ginsburg, SotomayorSlide8

Medicaid Expansion

I.

NFIB v. Sebelius

: Constitutionality of Medicaid Expansion under the Affordable Care Act

II. Past, Present, and Future: A glimpse at Medicaid Establishment and ExpansionSlide9

Past: Establishment of MedicaidSlide10

Past: Medicaid Establishment

Establishment of Medicaid

Established in 1965 as a jointly funded cooperative between federal and state governments

Purpose

: Provide medical benefits to those who have either no or inadequate medical insurance

Program requirements

: Established by each state and eligibility varies per stateSlide11

Past: Medicaid Establishment

Tennessee’s Response to Medicaid Enactment

Established TennCare in 1994

Serves roughly 18-19% of the state’s population

Two types of TennCare:

TennCare Medicaid

and

TennCare StandardSlide12

Past: Medicaid Establishment

For:

Tennesseans who are eligible for Medicaid

Groups covered include: Children under 21, pregnant women, single parents of minor child, elderly, and disabled

Income limits are applicable

For:

Children under 19 who are already enrolled in TennCare Medicaid

AND

Lack access to group health insurance

OR

Time of eligibility for TennCare Medicaid is ending and they no longer qualify

TennCare Medicaid

TennCare StandardSlide13

Present: Tennessee without Medicaid ExpansionSlide14

Present: Tennessee without Medicaid Expansion

Current source of Tennesseans HealthCare coverage

Location

Employer

Individual

Medicaid

Medicare

Other Public

Uninsured

Total

TN

47%

5%

18%

14%

2%

14%

100%Slide15

Present: Tennessee without Medicaid Expansion

Tennessee Compared to United StatesSlide16

Future: Medicaid Expansion

Affordable Care Act gives states the option to expand Medicaid coverage to nonelderly adults with incomes up to 138% of the federal poverty level (FPL)Slide17

Future: Medicaid ExpansionSlide18

Future: Medicaid Expansion

Means that Tennessee can extend TennCare coverage to individuals up to 138% FPL

Persons in household

Poverty Guideline

133%

138%

400%

1

$11,490

$15,282

$15,856

$45,960

2

$15,510

$20,628

$21,404

$62,040

3

$19,530

$25,975

$26,952

$78,120

4

$23,550

$31,322

$32,500

$94,200Slide19

Future: Medicaid Expansion

No deadline by which states must decide whether to expand or not

No partial expansion-

all

or

nothing

Effects of expansionSlide20

Future: Medicaid Expansion

Effects of Expansion

Effect on people below 100% FPLSlide21

Future: Medicaid Expansion

Effects of ExpansionSlide22

Future: Medicaid Expansion

Effects of Expansion

Effect on people below 100% FPL

Financial Effects of ExpansionSlide23

Financial Effects of Expansion

100% for first three years (2014, 2015, 2016)

95% in 2017

94% in 2018

93% in 2019

90% thereafter

Approx. $31 million in 2017

Approx. $95 million in 2019

Federal Government will pay

Tennessee’s Increased CostsSlide24

Future: Medicaid Expansion

Effects of Expansion

Effect on people below 100% FPL

Financial Effects of Expansion

Effects of the Eligible but not Enrolled (EBNE)Slide25

Effects of the EBNE

Individuals who are currently eligible for Medicaid but not enrolled will likely go to exchanges and be automatically moved to TennCare

State will pay approximately 35% of the cost of covering this group

“Woodwork effect”

May be over 60,000 EBNE individuals who enroll in TennCareSlide26

Future: Medicaid Expansion

Effects of Expansion

Effect on people below 100% FPL

Financial Effects of Expansion

Effects of the Eligible but not Enrolled (EBNE)

Effects on healthcare availability Slide27

Effects on Healthcare Availability

More than 220,000 (and possibly up to 370,000) additional Tennesseans who are not currently eligible for TennCare would become eligible if expanded

Expansion would result in 24.7% reduction in overall number of uninsured in TennesseeSlide28

Where do States stand on Expansion?

Future: Medicaid ExpansionSlide29

Where do states stand?Slide30

Medicaid Expansion?