After Obama, Some Health Reforms May Prove Lasting - New York Times
Justin Kloski learned that he qualified for Medicaid under the worst of circumstances. The student and part-time lawn-company worker had lost 20 pounds, could not shake a nagging cough and was sleeping 14 hours a day when he decided to visit a clinic in Muncie, Ind., that provides free care for the poor and uninsured. A clinic employee invited Mr. Kloski, now 28, to apply for Medicaid.
A few days later, he took his new coverage to the emergency room at IU Health Ball Memorial Hospital in Muncie. A CT scan found a 15-centimeter tumor in his chest, so big it was pressing on his windpipe. In May 2015, he learned he had Hodgkin’s lymphoma, a form of cancer that is curable if caught early.
The Affordable Care Act, and Governor Pence’s decision to go against many other Republican governors and expand Medicaid under the law, may well have saved Mr. Kloski’s life.
He is among more than 400,000 Indiana residents — many of them previously uninsured — who have enrolled in Medicaid since Mr. Pence expanded it in 2015, the 10th Republican governor to do so. Under the terms of the health law, anyone with income up to 138 percent of the poverty level, or approximately $16,500 a year for an individual, now qualifies in states that opt to expand the program.
IU Health says it receives more Medicaid payments than any other health care provider in the state. Since the expansion began, the percentage of patients with Medicaid has grown to 23.2 from 20.7.
At the same time, the percentage of IU Health patients who are uninsured has fallen to 2.2 from 5.
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Ilana Panich-Linsman for The New York Times
In 2015 alone, the health system enrolled 14,000 people in Medicaid or private coverage, sometimes even signing up patients as they lay in hospital beds.
“We went all in because it’s a pretty big deal to us,” said Jonathan W. Vanator, IU Health’s vice president for revenue cycle services.
In the first nine months of last year, IU Health officials said, the amount of bad debt owed by patients and referred to collection agencies totaled $233 million, a 23 percent reduction from the comparable period in 2015, thanks largely to Mr. Obama’s health law.
But, the officials added, these gains have been largely offset by cuts in Medicare reimbursements and other federal funds under a law that has given and taken away.
Mr. Murphy is among many hospital executives now anxious about the possibility of seeing a bump in uninsured patients if the health law is repealed, while not getting back the federal funds they gave up under the health law. “I do think it would be problematic if part of the deal was changed and not the whole deal,” he said.
Mr. Pence expanded Medicaid only after the Obama administration agreed to let Indiana do it in its own way: Instead of getting virtually free coverage, as Medicaid recipients in many other states do, people enrolled in Indiana’s expansion pay up to 5 percent of their income toward it. Mr. Trump appears interested in promoting Indiana’s “personal responsibility” model: He has picked its chief architect, Seema Verma, to run the Centers for Medicare and Medicaid Services.
Since Mr. Kloski had no income when he enrolled, he paid $1 a month; he has since been classified as “medically frail” and does not have to pay anything.
Medicaid has paid for virtually all of his cancer care, including a one-week hospitalization after the diagnosis, months of chemotherapy, and frequent scans and blood tests.
But Mr. Kloski and his mother, Renee Epperson, are still not fans of the health law over all. They believed that it required that Mr. Kloski be dropped, when he turned 26, from the health plan his mother has through her job at Target — not understanding that it was the law that kept him on the plan until he was 26.
Mr. Kloski paid a penalty for going uninsured in 2014 rather than even explore whether he might qualify for a subsidy and find an affordable private plan through the marketplaces.
“There were so many horror stories about how expensive it was going to be,” Ms. Epperson, 47, recalled. “Justin said, ‘I’m not even going to try it, Mom.’”
And until they were interviewed for this article, the mother and son did not know that the law was responsible for the expansion of Medicaid that Mr. Kloski benefited from. Neither voted in last year’s presidential election; Ms. Epperson said that she disliked both candidates, and that even though Hillary Clinton supported the Affordable Care Act, she found Mrs. Clinton’s positions unacceptable on too many other issues, like abortion rights, to support her.
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Ilana Panich-Linsman for The New York Times
Still, she said, she ardently hopes that Mr. Trump and the Republican Congress will continue allowing low-income adults like her son to qualify for Medicaid.
“Oh my God, yes,” she said. “Absolutely.”
As for Mr. Murphy, IU Health’s chief executive, he said that while he did not want to think too much about changes that were still hypothetical, the prospect of losing the Medicaid expansion made him anxious.
“I worry about lots of things,” he said. “That list is probably 50 long, and this is definitely on that list.”
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