COVID-19 makes expanding Medicaid even more vital

The COVID-19 pandemic has had a devastating impact on the health of communities across the southeastern United States, including here in Tennessee. This has been exacerbated by high numbers of residents lacking insurance in Tenn. and throughout the region.

Approximately 300,000 Tennesseans are unable to afford health insurance, and over 10% of Tennessee's population lacks health care coverage, resulting in significant geographic, racial and socioeconomic disparities in health outcomes. A critical component of any response to COVID-19 is addressing the health insurance coverage gap – a gap that is largely the result of Tennessee's failure to expand Medicaid. Medicaid expansion is Tennessee's best hope of closing the state's health care coverage gap, and COVID-19 presents a unique opportunity to act.

A central tenant of the Affordable Care Act was expanding Medicaid coverage to non-elderly adults with annual incomes below 138% of the poverty line (approximately $17,600 per year). Thirty-eight states have expanded Medicaid since the law was passed in 2010, extending health care coverage to more than 12 million Americans. The positive effects of expansion can be seen when comparing health outcomes between expansion states and non-expansion states.

The disparities between the two groups have only become more apparent during the COVID-19 pandemic. States that expanded Medicaid prior to the pandemic had substantially lower uninsured rates and populations that were better connected to health care than non-expansion states.

Further, in non-expansion states, many people who would gain coverage through expansion are those at highest risk of infection or severe illness from COVID-19. This includes people with underlying chronic medical conditions, disabilities and racial/ethnic minorities. This also includes an estimated 30% of essential workers (approximately 650,000 people) who are uninsured in non-expansion states. Expanding Medicaid coverage in the 12 remaining non-expansion states would provide necessary health care coverage.

Congress is debating a reconciliation package that includes Medicaid expansion. The proposed package would effectively bypass state legislatures and create a federal Medicaid program that residents of non-expansion states could use beginning in 2025. Prior to 2025, low-income individuals would qualify for subsidized coverage on the Affordable Care Act's exchanges. This measure would offer low-income Tennesseans health care coverage that is desperately needed in the face of a pandemic that has left many with unforeseen medical expenses.

The Tennessee General Assembly has repeatedly failed to close the health insurance gap for the state's most vulnerable residents. The reconciliation package proposed by Congress offers hope of finally closing this gap through subsided insurance coverage and ultimately the creation of a federal Medicaid program. Critics of the reconciliation bill cite concerns about the cost of this package, proposed increases in corporate and international taxes, and resistance to expanding "welfare" programs as reasons for opposing this bill.

COVID-19 is our wake-up call about the consequences of underinvestment in public health and has shown that we can no longer afford to ignore the insurance gap. Please tell our members Congress it is time to act and to support this reconciliation bill.

Kevin M. Gibas is an infectious diseases doctor at Vanderbilt University Medical Center as well as a student at the Vanderbilt University School of Medicine.

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Kevin M. Gibas

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