There are still big hurdles for the Affordable Care Act – and Medicaid expansion is one of them, said Sarah Kliff, a senior editor at media startup Vox, who spoke at the Sunflower Foundation’s Advocacy in Health series Wednesday afternoon.
Kliff spoke about what’s next for the Affordable Care Act and how political perception could affect the ongoing implementation of the law. Kansas is one of several states that has not yet made a decision to expand Medicaid – a program for the poor and disabled – so that more people can have access to health insurance.
“Obamacare is still very controversial,” Kliff said. “Midterms are around the corner and I think if you’re a conservative legislator the last thing you probably want to do is associate yourself with a program supporting Obamacare.”
However, there are several states with Republican governors who are working on alternatives to traditional expansion, including Arkansas, Kliff said.
There is no doubt that the rollout of HealthCare.gov – a major pillar of the Affordable Care Act – was a disaster, Kliff said.
But the government surpassed its goal of enrolling 7 million Americans, and the biggest surge in enrollment was right before the deadline in March.
“On a policy level it’s not particularly important that the White House beat the 7 million projection. It’s more of a political yardstick in Washington. Did they hit the metric? Did they not?” Kliff said.
“But what’s going to matter more policy-wise is who signed up, how healthy they are, how much insurance they’re going to use. What the 8 million number tells me is there are people out there who want to buy the thing the Obama administration is selling on the exchange.”
“And actually, what this really terrible rollout tells us is that they want it so much that they’re going to deal with a website that doesn’t really work. A lot of people I talked to tried upward of 20 times to buy health insurance.”
The biggest barrier to coverage is cost, Kliff said. She mentioned a Kaiser poll that showed 39 percent of the uninsured who were eligible said they didn’t get coverage because it was too expensive.
And it’s clear that many Americans still don’t understand the law, she said.
Last spring, a Kaiser Family Foundation poll showed that 4 in 10 Americans weren’t sure if the health law was still standing.
The anxiety over the success of the Affordable Care Act and reluctance of people to sign up is similar to when the Medicaid program first rolled out, Kliff said.
“When Medicaid started in 1966, it actually only had half the states on board,” Kliff said. “It was then an optional program and still is an optional program. A state could pull out of Medicaid tomorrow if they decided not to (participate), but it turns out states really like federal money so they tend to stay in the Medicaid program. We did not get to all 50 states on Medicaid until 1989.”
Kliff, along with other journalists, left the Washington Post for Vox earlier this year. While at the Post, she covered health policy and helped found Wonkblog, which covered government policy. She previously covered health policy at Politico.
The Sunflower Foundation, which is in Topeka, was formed in 2000 as part of a $75 million settlement between Blue Cross and Blue Shield of Kansas, the state attorney general and the insurance commissioner. It was formed to resolve lawsuits over Blue Cross’ charitable assets from 1941 to 1969, according to its website.
Its goal is to help improve the health of Kansans through programs that focus on preventive health care, reducing tobacco use and serving the poor and uninsured.