Friday, April 20, 2018
Opinion

Column: Rejecting Medicaid: terrible deal

Curious why some hard-core conservative governors, including Rick Scott of Florida and Jan Brewer of Arizona, are fighting with their legislators to accept Obamacare's Medicaid expansion? A new study in the journal Health Affairs article will clear it up. • The study, by the Rand Corporation, looks at the 14 states that have said they will opt out of the new Medicaid funds. It finds that the result will be they get $8.4 billion less in federal funding, have to spend an extra $1 billion in uncompensated care, and end up with about 3.6 million fewer insured residents.

So then, the math works out like this: States rejecting the expansion will spend much more, get much, much less, and leave millions of their residents uninsured. That's a lot of self-inflicted pain to make a political point.

It's a truism of health care politics that the uninsured are impossible to organize. But Obamacare creates an extraordinarily unusual situation.

The Affordable Care Act will be implemented in states that reject Medicaid. There will be huge mobilization efforts in those states, too, as well as lots of press coverage of the new law. The campaign to tell people making between 133 and 400 percent of poverty that they can get some help buying insurance will catch quite a few people making less than that in its net. And then those people will be told that they would get health insurance entirely for free but for an act of their governor and/or state legislature.

Typically, in politics, there's no guarantee that winning an election will get anything big done. Politicians talk about ending wars and reforming health care, but then they take office, have one meeting with the chairman of the relevant committee, and back off.

Here, however, federal law already says Americans making less than 133 percent of poverty are entitled to Medicaid coverage. All that needs to happen is for recalcitrant state governors and legislators to get out of the way. The publicity the benefit will get, the value it has to the target population, and the clear political path to getting that benefit all present an extraordinary organizing opportunity.

In Texas, for instance, 38 percent of the Hispanic population is uninsured. Will having that security so near, and then learning that it's been blocked by their government, activate that voting bloc in the way Prop 187 did in California?

It's a possibility National Journal columnist Ron Brownstein raised in a recent article. "In 1994, California Republican Gov. Pete Wilson mobilized his base by promoting Proposition 187, a ballot initiative to deny services to illegal immigrants. He won re-election that year — and then lost the war as Hispanics stampeded from the GOP and helped turn the state lastingly Democratic. Texas Republicans wouldn't be threatened as quickly, but they may someday judge their impending decision on expanding Medicaid as a similar turning point."

© 2013 Washington Post

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