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Expand Medicaid

Published January 19, 2013 1:01 am

Counties need the mental health aid
This is an archived article that was published on sltrib.com in 2013, and information in the article may be outdated.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.

It is, generally, a conservative dictum that the level of government that is closest to the people is the most important. A corollary of that is that higher levels of government should not impose unfunded mandates on lower levels.

So last week's unanimous vote of the Salt Lake County Council, urging the state of Utah to expand its Medicaid program as envisioned in the federal Affordable Care Act, is something the self-described conservatives in the governor's office and in the Legislature should heed.

Medicaid expansion is not a mandate. The Supreme Court ruling that upheld the overall law — also known as Obamacare — also freed states from the requirement that they expand Medicaid eligibility.

And it is not unfunded. The federal government will pay 100 percent of the cost for the first three years. After that, state and local costs for handling the increased eligibility will never rise above 10 percent of the total.

So the costs are somewhere between little and nothing, while the benefits stand to be huge, for the poor, the sick and the taxpayer.

The particular benefit that caught the County Council's eye is that expanded Medicaid will provide mental health care for its beneficiaries. Today in Utah, Medicaid covers so few people that the cost of providing mental health services for the uninsured falls squarely on county governments across the state.

That creates both a burden on local taxpayers and a limit on the number of people who can get services they desperately need. Unmet mental health needs do not cause suffering only for the untreated patient. They put at risk family members, neighbors, passers-by and, sometimes, police officers. Too often, those with unmet mental health needs commit violent acts and end up in jail, where they further add to the local taxpayers' burden, even as they receive little or no treatment.

Salt Lake County officials figure that no more than $5 million in local and state contributions could leverage $50 million in federal money for mental health services, services that the county must provide no matter what.

Republican governors in Nevada and Arizona favor the expansion of Medicaid in their states. They have done so based on the sound conservative thinking that it will allow them to do more for their constituents without raising state taxes or siphoning away money from other needed services.

Only the most ideologically stubborn would turn down the ACA opportunity to serve so many more poor, sick and mentally ill people for such a small investment of state and local money. Utah should get with this program.