Opinion | It’s time to expand Medicaid

Universal healthcare is in sight, Medicaid expansion is the way forward.


Grace Smith

The Iowa State Capitol is seen before the opening of the 2022 Legislative Session in Des Moines, Iowa, on Monday, Jan. 10, 2022.

Shahab Khan, Opinions Columnist

After the Affordable Care Act allowed states to expand Medicaid, Iowa gave hundreds of thousands of people health insurance.

Despite this achievement, there is still more that the state government can do.

It is in the interest of the Iowa Legislature to ensure that every Iowan has access to health care by expanding Medicaid even further.

When liberals and progressives complain about American health insurance, they tend to bemoan over its lack of universality.

From 1965 until 2010, Americans primarily received their health insurance from their employer. Those in retirement were insured under Medicare. Medicaid, on the other hand, was reserved for low-income children, pregnant people, those with disabilities, and parents with young children.

A substantial number of Americans were either too young to qualify for Medicare, however, or did not meet the criteria for Medicaid. As a result, around 46 million Americans—and 8.1 percent of Iowans—did not have access to health insurance.

This changed in 2010 with the passage of the Affordable Care Act which is colloquially known as Obamacare.

The most important legacy of Obamacare was that it gave the states the option for Medicaid expansion. This meant that so long as someone was making under 138 percent of the federal poverty line, they would qualify for Medicaid.

This expansion is the principal reason why the percentage of uninsured Americans decreased to 31.6 million in 2022. In Iowa, the rate of uninsured dropped to 6 percent.

The bad news is that even with the Medicaid expansion provided by Obamacare, as the 138 percent ceiling leaves many Iowans uninsured. Fortunately, states have the ability to set their own qualification levels.

The precursor to Obamacare, the Commonwealth Health Insurance Connector Authority in Massachusetts, subsidized healthcare for those making under 300 percent of the federal poverty line. Iowa lawmakers should look to adopt a similar policy by raising the income ceiling to qualify for Medicaid.

Of course, conservatives oppose any type of Medicaid expansion. The ghouls in this group normally screech about how government supported health care will put the country on track to communism and economic ruin.

Almost all developed countries with free-market economies have some form of government supported health insurance. These countries also have robust economies, coupled with higher life expectancy compared to the U.S.

Furthermore, Obamacare does not even disrupt private health insurance markets. Instead, the primary mechanism that makes Obamacare work is that it allows previously uninsured people to buy coverage through subsidies or uninsured people could just enroll in Medicaid. Nobody lost their private insurance.

While Medicaid is far from a perfect program, when previously uninsured people gain access to the program, their quality of life increases dramatically as they are able to actually see a doctor more frequently and actually be able to pay for costly procedures they need.

The simple truth is that when people have health insurance, their quality of life improves.

It is thus the responsibility of these lawmakers to allow more people to benefit from the Medicaid expansion and afford life-saving health insurance.

Columns reflect the opinions of the authors and are not necessarily those of the Editorial Board, The Daily Iowan, or other organizations in which the author may be involved.