Lawmakers must accept Medicaid expansion

January 13, 2013 

When state legislators convene the 2013 session Monday, they will be looking for areas of mutual agreement that can be dealt with quickly, as well as easily identifiable expense savings, all in preparation for the final days of the budget battle in March.

One item they should tackle immediately: accepting the additional Medicaid funding from the federal government provided by Obamacare.

Choosing to proceed with a major expansion of Medicaid will save the state $225 million in the 2013-2015 biennium, provide health care coverage to about 1 million uninsured Washingtonians and finally create a health care system out of currently fragmented and oft-competing interests.

When the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act, commonly known as Obamacare, it did so with the caveat that states could not be forced to accept the federal Medicaid dollars. Each state, the high court ruled, must choose to accept the funds willingly.

Washington state lawmakers should just say yes.

Even conservative state senators and representatives, who may harbor some ideological objection to Obamacare, should see the immense value in accepting Medicaid expansion. For support, they need look no further than the conservative state of Idaho, where a statewide commission unanimously recommended expanding the program.

Here’s why it makes sense for Washington:

First, it will save the state millions of dollars. The Washington State Budget & Policy Center estimates the savings at $225 million over the next biennium. That’s money the Legislature can put toward meeting its K-12 basic education obligation and fill the estimated $900 million budget deficit.

Second, refusing the Medicaid expansion funds just gives money from Washington state to those states that do expand their Medicaid program.

The national Medicaid expansion program is being funded primarily by hospitals, in the form of reductions to their Medicare payment rate.

Len McComb, of the Washington State Hospital Association, says Washington’s hospitals, including Capital Medical Center and Providence St. Peter’s Hospital, will lose more than $3.1 billion in Medicare reimbursements.

Why send that money to other states? And, those rate reductions to our hospitals will occur whether or not Washington accepts the money.

Third, the federal government is picking up the tab for extending insurance to most of the state’s 1 million uninsured through Medicaid or privately, through the Health Care Exchange.

The feds will pay for 100 percent of the cost of bringing previously ineligible people into the system for three years, and then gradually lowering the contribution to 90 percent in 2020 and beyond.

That is a significant savings to the state, which now receives a 50-50 match.

Fourth, an estimated 350,000 in Washington would gain coverage. That number includes 261,000 people who would become newly eligible for Medicaid if the state agrees to expand the program.

Medicaid expansion would change the rules and make eligibility dependent on income alone. Any individual making less than $15,000 per year, equivalent to 138 percent of the federal poverty level, would qualify.

That fact alone should appeal to conservative lawmakers from Eastern Washington where the percentage of uninsured people ranges from 35 percent to 50 percent or more. Fewer than 30 percent of Thurston County residents are uninsured, as is the case in most of the Puget Sound counties.

That means the poorer rural counties will benefit the most.

Fifth, the expansion would extend coverage to baby boomers in the 50 to 64 age category who do not have insurance, perhaps due to recent job loss, and do not yet qualify for Medicare.

Lastly, the expansion would indirectly benefit our community, as more people gain access to appropriate health care services.

State Insurance Commissioner Mike Kreidler estimates that people with insurance pay about $1 billion per year through their premiums to cover the costs of the uninsured who are using hospital emergency rooms, community health clinics and even the 911 system inappropriately.

For all of these reasons, it makes no sense for Washington to opt out of Medicaid expansion.

Surely, state lawmakers and Gov. Jay Inslee can agree on such a win-win for the people of Washington state.

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