The Medicaid Contraction?

The Supreme Court's ruling on the healthcare mandate was bittersweet. The Affordable Care Act's greatest virtue was the expansion of Medicaid to include all persons under 133 percent of the poverty line. That meant that every family of four earning less than roughly $31,000 would be covered; that amounted to between 16 and 18 million new enrollees and almost half of all the people to be newly insured by the ACA. But on Thursday, the highest Court determined that the "forced" expansion (states who failed to comply faced losing all their Medicaid funding) was unconstitutional.

This isn't all bad. States are still  allowed to opt in, which is a good thing given that the ranks of the poor have been growing. Since the Great Recession took hold, the Medicaid roles have swelled by an additional 3.3 million people. States typically take on more than 40 percent of the costs of each new enrollee. Under Obamacare, new enrollees will be funded 100 percent by the Feds for the first few years and the 90 percent by Washington the rest of the way. So while the existing enrollees place a real strain on local governments, the expanded coverage comes at a fraction of the cost.

But several GOP governors contend that they don't care how much less these enrollees cost because they can't afford even a marginal increase. Governor Dave Heineman of Nebraska has mistakenly referred to expansion as "unfunded" while deriding its potential effects on other state priorities. Governor Phil Bryant of Mississippi carped that the Medicaid expansion will come at the expense of jobs, education, and public safety. Bobby Jindal of Louisiana and Scott Walker of Wisconsin have decided to wait and see, hoping that a Romney adminstration will result in the repeal of the Affordable Care Act.

This is all ridiculous. Residents of these states and others need this Medicare expansion. A 2011 report from MIT and the Harvard School of Public Health revealed that the potential health benefits of Medicaid include (1) significantly higher health care utilization (including primary and preventive care as well as hospitalizations),(2) lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection), and (3) better self-reported physical and mental health than the control group. Other findings include that women were 60 percent more likely to have mammograms and recipients overall were 20 percent more likely to have their cholesterol checked.

Turning down a deal that amounts to 90 percent discount on vital services is unfortunately the lingua franca of today's Republican party. When their presidential nominees suggested that they would reject 10:1 spending cuts to tax increases, many of us thought they were merely pandering. This Medicaid battle may give us every indication that they are dead serious.