Wednesday, January 01, 2014

Medicaid expansion -- but only in certain states -- seems more important than individual coverage thru exchanges

Medicaid expands today in many states (those which “accepted” the expansion with Obamacare) and may become a more significant source of health insurance for the previously uninured than the exchanges, according to a New Years Day story by Sandhya Somahhekhar and Karen Tumultry in the Washington Post, link here.
But many red states refused to accept the invitation. In those states, people barely above the poverty line (which will often be single and childless people) can get federal subsidies to buy private insurance, but cannot get Medicaid, which would have been cheaper for the federal government.  It is true that Medicaid will no longer look at assets the way it did (except for nursing home stays). 
The Supreme Court ruled that the federal government cannot compel the states to accept Medicaid expansion.  Why did so many, like Texas, refuse what sounds like a good deal for states that have to balance their budgets?  States say that they think they will get stuck with something, but the main issue seems to be ideology, the idea that Medicaid is an extension of welfare and public assistance.
The article points out the Arizona alone did not join Medicaid until 1982.  But when I was working for Bradford in 1977 on New York State MMIS, I worked with a woman who had written a detail design for the reporting system for the upcoming system for Arizona, which we adopted.  I’m surprised to hear that it took until 1982 to be implemented.

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