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Washington Post: Medicaid expansion a no-brainer

First Published Feb 10 2014 10:26 am • Last Updated Feb 10 2014 10:26 am

New Hampshire looks like it will be the next state to assent to the obvious and accept buckets of federal money to offer its poor citizens health-care coverage. Finally, a bare majority of states will have made this no-brainer of a policy choice, implementing the section of Affordable Care Act (ACA) meant to help low-income Americans. Every time another state joins the ranks of the rational, it should embarrass states such as Virginia, which still hold out in blinkered opposition to anything related to Obamacare, no matter how good a deal this provision is for them.

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Until the ACA passed, Medicaid was mostly for very poor families with children. The new law offered Medicaid coverage to people (including childless adults) who earn up to 138 percent of the poverty line, with the federal Treasury picking up the whole tab for new clients for the first three years and nearly all of it in later years. The U.S. Supreme Court unwisely made this shift optional for states. Many opted in, but many red states flatly refused. Others, such as Arkansas, Michigan and, now, New Hampshire, decided to take the federal cash and cover about the same number of poor people, but they will significantly change how they do it.

Federal authorities have rightly cooperated with these efforts, issuing waivers to states with reasonable coverage plans. These plans often involve helping people obtain private insurance, discouraging them from overusing the emergency room or giving them skin in the game by demanding that they pay a certain portion of their health-care costs. The most important thing is to use the money to cover poor people; if these plans are the easiest paths for leaders in red or purple states to overcome GOP opposition, we welcome them.

That’s how we view a proposal now emerging in Virginia’s Senate, which is similar to the coverage deals other states have struck. The plan would take federal Medicaid money and give it to the nearly 400,000 Virginians hovering around the poverty line, helping them buy private insurance in a new insurance marketplace. Beneficiaries would be on the hook to pay up to 5 percent of their incomes to defray their health-care costs. The plan has the backing of some Senate Republicans, and a spokesman for Gov. Terry McAuliffe, a Democrat, welcomed the proposal. The big roadblock is the GOP-controlled House of Delegates, which refuses to entertain even a compromise plan.

Using allocated federal money to expand the availability of health-care coverage for some of the most vulnerable is a cause worth fighting for — in Virginia and every other holdout state. Virginia’s Senate should include the plan in its budget, and if the House doesn’t accept the proposal, the matter must come back into play during budget negotiations between the two bodies. The alternative is leaving hundreds of thousands of people without access to affordable coverage while people above and below them get help from other federal health-care provisions — and while Virginia’s citizens pay federal taxes to fund the coverage expansion but get none of those dollars back.




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