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Op-ed: Expand Medicaid to address Utah's mental health needs
This is an archived article that was published on sltrib.com in 2013, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

The National Association of Social Workers, Utah Chapter, supports the Medicaid expansion solution for Utah. Expanding Medicaid will broaden health care coverage to tens of thousands of uninsured Utah citizens, provide essential health and mental health services and promote healthier, more viable communities.

The 2010 Patient Protection and Affordable Care Act (ACA) is the most significant piece of U.S. healthcare legislation since the enactment of Medicare and Medicaid in 1965. However, one component of the ACA — expansion of Medicaid coverage to individuals with incomes below 133 percent of the federal poverty level — is not mandatory. States have the option to extend Medicaid eligibility to this population.

We believe that Medicaid expansion is a good deal for Utah. The federal government will cover the full cost for all newly eligible Medicaid enrollees from 2014 to 2016. Thereafter, the federal share gradually diminishes to 90 percent. The millions of additional federal dollars coming into Utah through the expansion will lower state healthcare spending by reducing the need for expensive emergency room visits and hospitalizations.

Much of the benefit of the ACA for the lowest income individuals in our communities will be foregone if Utah chooses not to expand Medicaid, as individuals below the poverty line are ineligible for subsidized coverage in the health insurance exchanges. This will leave millions of people, including the working poor, without health coverage, creating a population that is "too poor for Obamacare."

As social workers, we have an ethical and professional responsibility to "advocate for changes to improve social conditions in order to meet basic human needs and promote social justice." At this time, there is no better way to fulfill this obligation than by advocating for implementation of the Medicaid expansion. There are currently 410,000 uninsured Utahns, and 253,188 Utahns currently enrolled in Medicaid. With expansion, those with Medicaid coverage would grow to 364,588. Of this expansion population, 30 percent to 40 percent will have mental health needs.

With expansion, most inmates would be eligible for Medicaid upon release from jail. There is significant evidence that ensuring that individuals have Medicaid coverage upon release from correctional facilities can contribute to reduced recidivism and create safer communities.

Medicaid expansion also will:

• Emphasize preventive care vs. high cost acute and higher level care.

• Emphasize community-based primary care physician care vs. expensive emergency room care.

• Create a more financially disciplined health care system.

• Result in a net deficit reduction, according to the Congressional Budget Office.

• Require that 80 - 85% of premiums must be spent on medical care or quality improvements.

• Create payments based on outcomes, preventing readmissions, etc.

• Provide insurance for more Utah citizens.

Utah must act now or risk losing millions of dollars designated to improve the health and well-being of our citizens. The federal money is already appropriated, but will be distributed to other states if Utah does not enact Medicaid expansion.

In addition to improving Utah's bottom line by limiting uncompensated care, Medicaid expansion will provide vital health care coverage to childless adults under the age of 65, as well as to uninsured families near the poverty line, making lifesaving health services, including mental health care, available to those who need it the most.

Emily W. Bleyl is executive director of the National Association of Social Workers, Utah Chapter, and Elise Hutchings is board president of the chapter.

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