Thursday, January 2, 2014

Why not expand Medicaid?

The primary purpose of the Affordable Care Act (Obamacare) is to make health insurance available to everyone. That’s a goal the GOP, the Heritage Foundation, and Democrats once shared. The law proposed doing that through several interlocking provisions.

There’s an individual mandate requiring everyone to purchase insurance and an employer mandate requiring certain larger employers to provide insurance for their employees. For those who can’t afford premiums, there are a series of tax credits and subsidies accompanied by mandatory and optional expansions of Medicaid coverage.

The law encourages states to expand Medicaid to low-income citizens unable to afford health insurance by having the feds pay nearly the entire cost.

Last year the Supreme Court created a playground for partisan politicians when it held that states couldn’t be forced to adopt the “optional” expansion. Anti-Obamacare pols took that as an opportunity to play politics rather than provide healthcare to low income workers.

Among them are Wyoming’s governor and Republican legislators. Why would they do that? That’s a good question voters should ask. Next week the Legislature’s committee on Labor, Health, and Social Services meets to consider Medicaid expansion. The Wyoming Association of Churches and others will greet them in the Herschler Building Plaza seeking an answer to that question.

With Medicaid expansion, payments will inject more than 860 million dollars into Wyoming’s healthcare infrastructure, creating hundreds of jobs. The costs of expansion will be borne fully by the federal government for the first years, gradually declining to 90%.

Programs Wyoming funds to meet the needs of the uninsured could be reduced or eliminated at a savings of tens of millions of tax dollars even as 17,000 uninsured Wyoming people could then afford healthcare.

So, why does the governor oppose this solution?

Mead says, “I don’t trust that the federal government will actually pay their share of the cost.” Really? Governor Mead submitted a “balanced” budget, as have all governors before him. His so-called “balanced” budget relies on the federal government to subsidize the state budget with more than 1.5 billion dollars.

Mead never suggests any concern about whether the feds will pay their share of all the other federal dollars on which Wyoming relies for everything from education to highways and healthcare rendering his claim they might not come through with their promise to pay for Medicaid expansion disingenuous at best.

Mead’s only example of any time the feds haven’t paid-up on a commitment was the reduction in Abandoned Mines Reclamation (AML) funds. Mead knows that argument is bogus.

AML funds were intended for only one purpose, to cleanup messes created by irresponsible mine operators. The list of awaiting Wyoming AML projects have a 482 million tab but Wyoming diverted those funds, spending the money instead on highways and university construction projects, including a $50 million appropriation for building the Michael B. Enzi STEM (Science, Technology, Engineering and Mathematics) facility.

As Wyoming writer Sam Western said in a essay, “It takes a few drinks, but adherents of even modest fiscal responsibility will admit that AML funding has strayed far from its intended purpose.” If not “a few drinks” how about a little intellectual honesty?

Congress’ decision to divert some of that money to deficit reduction might well have been different if states had used the money as intended. Congress has never reneged on any of its commitments to pay its share of Medicaid.

Then Mead says he thinks the Obamacare website will never work. The experiences of millions of Americans with an improved website belies that claim. Even so, the website has nothing to do with Medicaid expansion. The uninsured who would receive Medicaid under the expansion will not be using the website.

Please join us on January 9th in the plaza between the Capitol Building and the Herschler Building as we greet legislators and the governor with a demand that they answer for why care more about politics than they care about the 17,000 Wyoming families they will leave uninsured if they don’t expand Medicaid.

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