The U.S. Supreme Court has upheld the underpinnings of Obamacare. President Barack Obama has won re-election, and by a comfortable margin in Washington. So it might seem like a fait accompli to accept the additional Medicaid funding that would expand coverage for the poor.
But some health care observers are worried, because Medicaid expansion still requires legislative authority to proceed. As attorney general, Rob McKenna argued that the feds were overstepping their authority by forcing states to take the money. The U.S. Supreme Court majority agreed, calling it a “gun to the head.”
So each state must decide to accept expansion. Conservative Idaho formed a commission to look at this issue, and panelists came back with a unanimous decision to take the money. We think a close examination in Washington would arrive at the same conclusion for four solid reasons.
First, some poor adults who were once ineligible are now eligible. For example, single men with no children. Under health care reform, an estimated 261,000 Washingtonians are newly eligible.
Second, the federal government is picking up 100 percent of the cost from 2014 to 2016. That contribution gradually declines until it reaches 90 percent by 2020 and beyond. The traditional federal-to-state funding ratio is closer to 50-50. From 2014 to 2020, Washington would spend 1.5 cents for every dollar the feds spend.
Third, the state would save an estimated $120 million from 2014 to 2020, according to Urban Institute calculations. That’s a powerful incentive for a state facing a $900 million budget shortfall and a potential $1 billion obligation to fix basic education funding.
Fourth, the benefits would be widespread, with the poorer rural counties being helped the most. Conservative legislators may balk at the expansion, but it’s their constituents who have the greatest need. A staggering 35 percent to 50 percent of the population in Adams, Whitman, Ferry, Pend Oreille, Asotin, Columbia, Walla Walla, Kittitas, Yakima, Cowlitz, Grays Harbor and Clallam counties is uninsured. As a result, hospitals and clinics are struggling to stay open, which threatens access to care for everybody.
In addition, community health clinics, such as the Community Health Association of Spokane, would be able to offer preventive and continuous care, which would curb more expensive care. Hospitals would get relief from the huge charity-care costs they incur.
AARP advocates the expansion because it’s concerned about the increasing number of people from 50 to 64 years old who don’t have health care coverage. When this population and its accumulated untreated illnesses hit Medicare age, the budgetary impact will be ugly.
The governors of several Southern states are vowing to reject Medicaid expansion on principle. As a result, millions of people in those states will suffer needlessly. Some will die. The federal dollars will be spent regardless, but somewhere else.
As a more pragmatic and compassionate state, Washington should take this deal. It’s a healthy choice – medically and fiscally.
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