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Twist in U.S. Health Law May Create Two-Tiered Medicaid

Colonoscopies, diabetes screenings and other preventative services mandated by the U.S. health law may be offered only to new Medicaid program enrollees next year, leaving existing patients with second-tier care, a study found.

Excluding people already in the Medicaid program for the poor may penalize a population more prone to chronic conditions, researchers from George Washington University said in an article published today in the journal Health Affairs. The 2010 Affordable Care Act guaranteed preventative screenings to almost all who enroll in the expanded version of Medicaid and states were given the option of whether to offer those services to people already in the program.

While the law provides some money to avoid such disparity, the federal incentives may be insufficient to change the minds of governors and legislators. Some states, including Virginia, Utah, Montana and Vermont, have decided it’s not worth the financial burden, said Sara Wilensky, a faculty member at George Washington University’s Department of Health Policy.

“Certainly a lot of poor people are going to be left out from these preventive services,” Wilensky, the lead author of the report, said in a telephone interview.

Most private and public insurance plans are required to offer the services that the U.S. Preventive Services Task Force gives either an A or B rating, indicating they are likely to provide at least a moderate benefit to the patient. Such services include cancer screenings, HIV testing, obesity counseling and tests related to cholesterol and blood pressure.

Supreme Court

“If these services are so crucial to good health that coverage of them is required for so many others, why were people who are currently on Medicaid left off of health reform’s prevention bandwagon?” the researchers asked.

About 25 million Americans are projected to gain insurance under the health-care law, including 13 million through the state-federal Medicaid program for the poor. The Medicaid expansion called for every state to expand eligibility to people making as much as 138 percent of the federal poverty level, or about $32,500 for a family of four this year.

The Supreme Court ruled last year that requiring the states to expand their Medicaid programs was unconstitutional. Since then, most Republican governors have balked at the expansion, citing costs to their states despite the federal government’s plans to cover 100 percent of the tab for the first three years and at least 90 percent in the years following.

As of July 1, 21 states have said they won’t expand Medicaid and 6 others are still debating what to do, according to data tracked by the Kaiser Family Foundation, a nonprofit group research based in Menlo Park, California.

Among the states that are expanding Medicaid, the researchers couldn’t definitively say how many would end up with a separate standard of preventive services for new enrollees versus existing beneficiaries.

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