Women in Poverty - Tales from the Recession's Front Lines

Part: 5

Hard Times Test Obama's Promise of More Medicaid

By Sharon Johnson

WeNews senior correspondent

Thursday, July 15, 2010

Health reform promised to extend Medicaid to numerous childless women. But with states struggling to balance their budgets, women's advocates fear a scaling back. They say it's crucial for Congress to authorize more funds in coming weeks.

President Obama signs the health insurance reform bill, March 23, 2010. (WOMENSENEWS)--The health care reform law signed by President Obama in March promised to add 16 million low-income Americans--many of them childless women who didn't qualify under the old rules--to the Medicaid rolls by 2020.

But women's health care advocates fear the current fiscal crisis threatens that goal in many states and are anxiously watching how Congress will vote on expanding Medicaid benefits.

"Expansion of Medicaid is the heart of the Obama health reform plan, so it is crucial that Congress pass a six-month expansion of extra funds for Medicaid when it returns to Washington this week," said Sara Finger, chair of the Madison-based Wisconsin Alliance of Women's Health, an independent network of organizations in the state. "Without Medicaid, poor women can't obtain basic medical services because it is a desperate struggle to keep a roof over one's head and put food on the table for one's family with an income at the poverty level."

While the House is widely expected to favor a Medicaid funding expansion, the Senate is expected to have a longer debate over the matter, leaving the vote pending until September. Summer recess for lawmakers begins Aug. 9 and goes through Sept. 12.

Poverty-level income was $10,830 for an individual and $22,050 for a family of four in 2009. The poverty rate for women was 13 percent in 2008, significantly higher than the rate for men, which was about 10 percent. Government sources won't have data for 2009 for several weeks.

With unemployment hovering around 10 percent nationally, enrollment in Medicaid is expected to increase 21 percent from 2009 to 2011, according to a June report by the National Governors Association and the Association of State Budget Officers.

Against that backdrop, 30 states face budget shortfalls by Dec. 31 unless the federal government assumes a greater share of the cost of providing health insurance for indigent children, pregnant women and disabled adults.

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Rising Costs Potentially Sink Budgets

Many states assumed that Congress would approve the extension and included the extra funds in their budgets for 2011. Now the states are worried that rising Medicaid costs will sink their budgets.

"There have already been significant cutbacks that have hurt women and the problem could get worse," said Anne S. Kasper, chair of the Maryland Women's Coalition for Health Care Reform in Bethesda. "Up to now, states have kept their Medicaid programs afloat by decreasing the reimbursement rate to physicians and other providers and limiting services like dental to tooth extractions. Many providers have dropped out of the program because they cannot afford to treat Medicaid patients. As a result, many women have had to wait longer for care or go without vital services."

The jobless rate for women in June was lower than for men; about 8 percent versus 10 percent. But women generally earn less than men and have fewer assets to tap during periods of extended unemployment.

Each year, the federal Medicaid matching rate--which stipulates the ratio of federal to state contributions--is calculated for each state and varies depending on average personal income in the state.

Before 2009, the federal rate averaged 57 percent nationwide, but the stimulus act raised the federal government's share to 66 percent. Some lower-income states received as much as 86 percent of their Medicaid funds from the federal government.

Shortfalls could be worse in 2011 because it takes three or four years after a national recession for tax receipts in the states to bounce back.