It hasn’t escaped my attention that many conservatives and Republicans would like to repeal the Patient Protection and Affordable Care Act (aka Obamacare). But until they do that, it’s fairly amazing (to me at least) that 24 (mostly pretty red) states (including two of the four most populous, Texas and Florida) have decided to reject the part of the law that would expand Medicaid so that it provided benefits for Americans with incomes up to 138 percent of the poverty level. (That would be an income of roughly $16,000 for an individual, and almost $34,000 for a family of four.)
At a forum on the law’s implementation Tuesday at the University of Minnesota’s Humphrey School, the view is that this will not last. Deborah Bachrach, now with the Manatt law firm in New York but who has held numerous health-insurance related positions inside and outside of government, noted in her presentation that it took 17 years after the 1965 enactment of Medicaid for all 50 states to participate in the program. (Arizona, the last holdout, joined in 1982.)
Bachrach doubts that all 24 of the current non-participant states will join in the year ahead, but she said, “we will get there in less than 17 years.”
Andy Allison, who led the implementation of the Affordable Care Act in Arkansas (a fairly red state with a Republican-controlled legislature, but it has a Democratic governor) said other states will join once the early adopters start demonstrating results. Allison said that in some circles, there is serious doubt about whether poor people benefit much from health insurance.
“Now we have a grand experiment which will prove that it does matter, and that’s why it won’t take 17 years” for the rest of the states to join the program, said Allison.
Brett Davis, Medicaid director in Wisconsin, a state that has not expanded Medicaid, said that his state doesn’t fit neatly into the division of adopters and rejecters because Wisconsin under Gov. Scott Walker has successfully implemented state-based changes that have expanded certain categories of health coverage for certain categories of low-income Wisconsinites.
The panel’s moderator, Larry Jacobs of the U of M’s Center for the Study of Politics and Governance, expressed some admiration for the new Wisconsin program, but asked how the state could choose to turn down the large number of federal dollars that would flow in to help insure the near-poor. Davis (himself a former legislator) replied that in Wisconsin, nothing that could be called “Medicaid expansion” could pass in the Legislature.
Minnesota State Sen. Matt Dean (R-Dellwood), who served as House majority leader in 2011-12, represented the Legislature on the panel. After his opening statement (which I could not follow), Jacobs said he was listening closely to discern whether Minnesota Republicans would try to pull out of the Medicaid expansion if they regained control of the Legislature. Dean said his caucus was interested in “expansion of the public option.” In the context of Medicaid expansion, I take it that the “public option,” which was also featured in the Arkansas program described by Allison, refers to using expanded Medicaid dollars to help qualified near-poor people buy insurance from private-sector providers.