Amidst all the bluster and looming changes in Washington, D.C., these days, is a whole lot of noise about a potential rollback of the Affordable Care Act (ACA), or Obamacare. And as in other states across the country, folks in Maryland are trying to figure out what those changes could mean for Medicaid in our own communities. While there are still no answers on that front, there are some things we do know, and some good things to keep in mind throughout the Medicaid debate as it unfolds in the days, weeks and months to come.

The impact of Medicaid expansion has been huge

Over the past few years, health coverage in Maryland has increased significantly, thanks in large part to the expansion of Medicaid made possible by the federal government’s widening of Medicaid eligibility requirements and increased Medicaid funding.

According to Maryland’s Department of Legislative Services:

• 1.2 million Marylanders are covered through Medicaid—that’s 20% of the state’s population
• 291,000 Marylanders are newly enrolled thanks to Medicaid expansion
• Medicaid expansion is the largest source of increased medical coverage in Maryland

Closer to home, Medicaid expansion has meant a much larger Health Care for the Homeless, with an ability to reach many more clients. In 2013, 30% of our clients were insured; today, 90% are insured—and 80% of that insurance is through Medicaid. And since 2013, we have both doubled in size and nearly doubled the number of clients we serve.

With these facts alone, it’s not hard to imagine what a reversal of Medicaid expansion could mean for Maryland and the Baltimore community we serve…

The Medicaid debate really isn’t a partisan issue after all…

Introduced in 1965 as a bipartisan fix to national health care needs, Medicaid has historically been backed by Republicans and Democrats alike. It comes with broad federal guidelines and significant state flexibility built in. In recent years, we’ve seen a shift in that bipartisan spirit, with Republicans working to cut Medicaid spending pitted against Democrats fighting to keep it. But the truer the threat of a Medicaid rollback, the less partisan the issue becomes. Of the 31 states that took advantage of Medicaid expansion, along with Washington, D.C., 16 are led by Republican governors. And many of those Republican governors are becoming increasingly vocal at the national level about the negative impact of a Medicaid rollback on their own states. So, despite all the political banter, it’s really not a partisan debate.

That said, we at Health Care for the Homeless are doing our part to make that clear and depoliticize the issue. To help remind our state of the bipartisan support and common-sense need for strong Medicaid funding, our own CEO, Kevin Lindamood, recently penned a letter to Governor Larry Hogan asking him to take a more active role in protecting the program. You can read Kevin’s letter here.

Keeping you in the know

In the days and months ahead, we’ll continue to keep an eye on changes to federal health care laws and the Medicaid conversation in Maryland. In the meantime, here are some things to keep on your radar:

• On January 25, the National Health Care for the Homeless Council held a webinar on the changes to medication-assisted treatment.
• On February 28, our monthly Board of Directors meeting will feature a presentation on Medicaid by Shannon McMahon, Deputy Secretary of Health Care Financing at the Department of Health and Mental Hygiene.

Recommended reading

To help wade through the complexity of the health care law and Medicaid’s potential future, here are some good reading resources that break it all down:

• Mobilizer, January 26, 2017 (the National Health Care for the Homeless Council's action alert focused on public policy issues related to homelessness and health care reform)
• Medicaid’s Future: What Might ACA Repeal Mean?, The Common Wealth Fund, January 2017
• ACA Round-up: Enrollment Report, Repeal Efforts, and More, Timothy Jost, Health Affairs Blog, January 11, 2017
• JAMA Forum: What Might an ACA Replacement Plan Look Like?, JAMA Forum, Larry Levitt, January 24, 2017