Doug and Mary Blair wait for appointment at the Breathitt County Family Health Center on Jan. 21, 2014 in Jackson, Ky. Mary Blair was able to receive medical coverage through Medicaid expansion under the Affordable Care Act.
Luke Sharrett for The Washington Post/Getty

Medicaid expansion starts to look even better

It’s been well documented that Medicaid expansion under the Affordable Care Act is an extremely good deal for states that choose to embrace it. The policy improves state finances and bolsters state hospitals, all while providing struggling families access to medical care. We’re occasionally reminded it’s even good for creating jobs.
 
MIT economist Jonathan Gruber, who helped design both Mitt Romney’s health care system in Massachusetts and President Obama’s ACA recently said he wasn’t overly concerned when the U.S. Supreme Court made Medicaid expansion optional for states. After all, he thought to himself at the time, “It’s not a big deal. What state would turn down free money from the federal government to cover their poorest citizens?”
 
We now know, of course, that nearly half the states have done exactly that for partisan reasons that the right struggles to explain. This week, however, the policy fight became even more one-sided – the Center on Budget and Policy Priorities noticed that a Congressional Budget Office analysis found that Medicaid expansion is “an even better deal for states than previously thought.”
CBO has sharply lowered its estimates of the costs to states of adopting the Medicaid expansion.
 
* CBO now estimates that the federal government will, on average, pick up more than 95 percent of the total cost of the Medicaid expansion and other health reform-related costs in Medicaid and the Children’s Health Insurance Program (CHIP) over the next ten years (2015-2024).
 
* States will spend only 1.6 percent more on Medicaid and CHIP due to health reform than they would have spent without health reform (see Figure 1).  That’s about one-third less than CBO projected in February. And the 1.6 percent figure is before counting the state savings that the Medicaid expansion will produce in state expenditures for services such as mental health and substance abuse treatment provided to the uninsured.
The full CBO report is online here (pdf).
 
And yet, despite all of this, we saw new evidence this week that Republican policymakers in some states are working to block Medicaid expansion, not just now, but also in the future.
 
Dylan Scott had a good report on this yesterday.
Republicans are taking no chances when it comes to Obamacare’s Medicaid expansion. They’re closing every possible door. Under bills passed in Georgia and Kansas recently, even if a Democratic candidate were to pull off an upset and take the governor’s seat, they would not be able to expand the program without the consent of the state legislature – which will almost certainly remain Republican.
 
In other words, GOP lawmakers have taken steps to guarantee that many of their poorest residents will remain uninsured under the health care reform law, no matter what happens in the gubernatorial election.
Here’s the deal: in some states, it’s up to the governor’s office to decide whether or not to embrace Medicaid expansion. For opponents of health care, this works out fine, just so long as there’s a far-right governor who’s prepared to ignore all of the evidence and obvious benefits.
 
But what if that governor loses?
 
In Georgia and Kansas, there are far-right incumbent governors who are favored to win re-election, but polls suggest their races will at least be competitive. It’s no longer ridiculous to think voters in either state – or perhaps both – could elect a Democratic governor who would, of course, do the smart thing when it came to Medicaid expansion.
 
The mere possibility has led legislators in Georgia and Kansas to push changes to state law, moving authority over the decision from the governor’s office to the legislature, just to make sure state finances, state hospitals, and the state’s struggling families will suffer now and in the future, regardless of who wins the gubernatorial races.
 
One Kansas Republican was quite candid in explaining his motivation for changing state law: “Governor Brownback’s not always going to be the governor.”
 

CBO, Georgia, Kansas and Medicaid

Medicaid expansion starts to look even better