As state legislative sessions advance, lawmakers are debating whether to expand their Medicaid programs as provided by President Barack Obama's health care law. It could be one of the most important decisions this year. So far 17 states and the District of Columbia have signaled they will go ahead, while 11 states are refusing. The rest are weighing options.
Some questions and answers:
Q: What is Medicaid?
A: Medicaid is a safety-net program envisioned as a partnership between the federal government and the states to cover low-income people, from severely disabled patients to healthy children and some parents. Since the 1960s, it has grown to a $400 billion-plus program, covering nearly 60 million people in the United States, or about 1 in 5. Some 30 million Medicaid beneficiaries are children, but the program also pays nursing home bills for low-income seniors and disabled people. Medicaid rules and coverage policies are different in every state. Nationally, the federal government's share of the cost averages nearly 60 percent.
Q: How does Obama's Affordable Care Act change Medicaid?
A: The health care law opened the program up to low-income adults with no children at home. Before that, states wanting to serve this group had to pay for it with their own money, and few states could afford it. Starting Jan. 1, 2014, the new law expands Medicaid eligibility to people making up to 138 percent of the federal poverty line, or about $15,400 for an individual. The Supreme Court gave states the right to refuse the Medicaid expansion without jeopardizing the rest of their program money. About half the people gaining coverage under the new law would so through Medicaid.
Q: What is the federal government offering my state?
A: Under the law, Washington will pay the full cost of the expansion the first three years, from 2014-2016. Thereafter, the federal share gradually phases down to 90 percent, still way more than the government pays for the rest of Medicaid. The nonpartisan Urban Institute estimates that $76 billion in state spending can trigger $952 billion in federal dollars over a decade.
Q: What are some arguments for the Medicaid expansion?
A: The program will provide coverage to millions of low-income people, most of whom are working and paying taxes that support other government health care programs, such as Medicare. Scholarly studies have shown that Medicaid coverage does improve access to medical care and people report they are in better health and not as worried about bills.
Hospitals, which by law must provide emergency care to the uninsured, will get an important new source of money to offset the cost of charity care. The financing will allow hospitals to add jobs, and will also have a positive economic impact on dozens of other businesses in local communities.
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