Quantcast
Get breaking news alerts via email

Click here to manage your alerts
This photo taken Jan. 18, 2013 shows part-time home health care provider Debra Walker in her home in Houston. President Barack Obama thinks his health care law makes states an offer they can't refuse. Whether to expand Medicaid _the federal-state program for the poor and disabled_ could be the most important decision facing governors and legislatures this year. The repercussions go beyond their budgets, directly affecting the well-being of residents and the finances of critical hospitals. Awaiting decisions are people like Walker, a part-time home health care provider. She had a good job with health insurance until she got laid off in 2007. (AP Photo/Pat Sullivan)
Money fears vs. real benefits in Medicaid choice
First Published Jan 28 2013 10:15 am • Last Updated Jan 28 2013 10:16 am

WASHINGTON • President Barack Obama thinks his health care law makes states an offer they can’t refuse.

Whether to expand Medicaid, the federal-state program for the poor and disabled, could be the most important decision facing governors and legislatures this year. The repercussions go beyond their budgets, directly affecting the well-being of residents and the finances of critical hospitals.

Join the Discussion
Post a Comment

Here’s the offer:

If states expand their Medicaid programs to cover millions of low-income people now left out, the federal government will pick up the full cost for the first three years and 90 percent over the long haul.

About 21 million uninsured people, most of them adults, eventually would gain health coverage if all the states agree.

Adding up the Medicaid costs under the law, less than $100 billion in state spending could trigger nearly $1 trillion in federal dollars over a decade, according to the nonpartisan Urban Institute.

"It’s the biggest expansion of Medicaid in a long time, and the biggest ever in terms of adults covered," said Mark McClellan, who ran Medicare and Medicaid when George W. Bush was president.

"Although the federal government is on the hook for most of the cost, Medicaid on the whole is one of the biggest items in state budgets and the fastest growing. So there are some understandable concerns about the financial implications and how implementation would work," McClellan said.

A major worry for states is that deficit-burdened Washington sooner or later will renege on the 90-percent deal. The regular Medicaid match rate averages closer to 50 percent. That would represent a significant cost shift to the states.

Many Republicans also are unwilling to keep expanding government programs, particularly one as complicated as Medicaid, which has a reputation for being inefficient and unwieldy.


story continues below
story continues below

Awaiting decisions are people such as Debra Walker of Houston, a part-time home health care provider. She had a good job with health insurance until she got laid off in 2007.

Walker was recently diagnosed with diabetes, and she’s trying to manage by getting discounted medications through a county program for low-income uninsured people.

Walker estimates she earned about $10,000 last year, which means she would qualify under the income cutoff for the Medicaid expansion. But that could happen only if Gov. Rick Perry, R-Texas, reconsiders his opposition.

"I think that would be awesome if the governor would allow that program to come into the state," Walker said. "That would be a help for me, robbing Paul to pay Peter for my medicines."

She seems determined to deal with her diabetes problem. "I don’t want to lose a limb later on in life," said Walker, 58. "I want to beat this. I don’t want to carry this around forever."

As Obama’s law was originally written, low-income people such as Walker would not have had to worry or wait. Roughly half the uninsured people gaining coverage under the law were expected to go into Medicaid. The middle-class uninsured would get taxpayer-subsidized private coverage in new insurance markets called exchanges.

But last year the Supreme Court gave states the right to opt out of the Medicaid expansion. The court upheld the rest of the law, including insurance exchanges and a mandate that virtually everyone in the United States have health coverage, or face a fine.

The health care law will go into full effect next Jan. 1, and states are scrambling to crunch the numbers and understand the Medicaid trade-offs.

States can refuse the expansion outright or indefinitely postpone a decision. But if states think they’ll ultimately end up taking the deal, there’s a big incentive to act now: The three years of full federal funding for newly eligible enrollees are only available from 2014 through 2016.

So far, 17 states and the District of Columbia have said they’ll take it. That group includes three Republican-led states, Arizona, Nevada and New Mexico. Arizona Gov. Jan Brewer was prominent among GOP leaders who had tried get the law overturned.

An additional 11 states, all led by Republicans, say they want no part of it. Perry says it tramples states’ rights.

Next Page >


Copyright 2014 The Salt Lake Tribune. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Top Reader Comments Read All Comments Post a Comment
Click here to read all comments   Click here to post a comment


About Reader Comments


Reader comments on sltrib.com are the opinions of the writer, not The Salt Lake Tribune. We will delete comments containing obscenities, personal attacks and inappropriate or offensive remarks. Flagrant or repeat violators will be banned. If you see an objectionable comment, please alert us by clicking the arrow on the upper right side of the comment and selecting "Flag comment as inappropriate". If you've recently registered with Disqus or aren't seeing your comments immediately, you may need to verify your email address. To do so, visit disqus.com/account.
See more about comments here.
Staying Connected
Videos
Jobs
Contests and Promotions
  • Search Obituaries
  • Place an Obituary

  • Search Cars
  • Search Homes
  • Search Jobs
  • Search Marketplace
  • Search Legal Notices

  • Other Services
  • Advertise With Us
  • Subscribe to the Newspaper
  • Access your e-Edition
  • Frequently Asked Questions
  • Contact a newsroom staff member
  • Access the Trib Archives
  • Privacy Policy
  • Missing your paper? Need to place your paper on vacation hold? For this and any other subscription related needs, click here or call 801.204.6100.