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Editorial: Medicaid expansion proving hard to pass up

Feb. 08, 2013 @ 12:05 AM

One of the biggest issues facing state governments this year is whether to expand Medicaid to a large number of lower-income residents who do not now have health insurance.

As part of the Affordable Health Care Act, the federal government has offered states a very attractive deal.

If states will expand Medicaid to include people who are at 150 percent of poverty level or below, the federal government will pay the entire cost of the expansion for three years and then 90 percent of it after that.

In most states, the very poor already are on Medicaid and many more children qualify for health insurance through programs such as the CHIPS program in West Virginia. But there is still a large group -- especially in West Virginia, Kentucky and Ohio -- who earn too much to qualify for Medicaid but do not have insurance through work or on their own.

The hope is that by giving more people access to routine health care, states will reduce and cut down on the poor health habits and chronic disease that drive higher health-care costs.

Of course, many of those who opposed the president's plan oppose the expansion as well. Their concerns include the huge cost to the federal government, and also the long-term costs to the individual states.

Although it is "free" initially, funding even 10 percent of the costs will be substantial, and some question whether the federal government can uphold its end of the bargain.

Ohio's Republican Gov. John Kasich surprised many this week by announcing that he will push for the expansion in his state, despite his outspoken opposition to "Obamacare." Officials in the Buckeye State estimate that will mean adding about 365,000 residents to the Medicaid rolls.

Kasich's explanation was more about business than ideology. If Ohio were to pass up the deal, federal tax dollars would be used to expand coverage elsewhere and give businesses in those states the competitive advantage of a healthier work force, he reasoned.

The Ohio governor also proposed an "opt-out" trigger -- if the federal government does not pay its share, the expansion would be shut down.

So far, about 17 states are planning to expand, and about 10 have indicated they will not.

West Virginia and Kentucky have yet to decide. Clearly, the increased long-term costs will be a challenge, but both states struggle with the poor, unhealthy populations that will benefit from the expansion. As Kasich points out, passing on a chance to improve that work force puts both states at an ever greater disadvantage when it comes to economic development as well as quality of life.



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