Bring Medicaid to the People

(Bloomberg View) -- The failure of Obamacare's opponents in Washington is prompting reconsideration among its opponents outside Washington. The end of the congressional effort to repeal the law has deprived leaders in 19 states of their rationale for rejecting federal money to expand Medicaid.

Expanding Medicaid enrollment to childless adults near the poverty line was one of the key goals of the Affordable Care Act, which boosted the number of people receiving care through Medicaid by more than 11 million, to 74 million. The cost, more than a half trillion dollars for Medicaid overall, is vast by almost any measure -- except as compared with the cost of private insurance plans, in which case it looks economical.  

The opponents' policy reasons for rejecting the additional money never made much sense. Expanding Medicaid would have allowed hundreds of thousands of their constituents to better afford health care. Yet the partisan and ideological impulse is strong -- most of these states are controlled by Republicans, and resisted both former President Obama and greater federal involvement in their states.

Yet it appears there will be no comprehensive Republican alternative to Obamacare. Instead, there is only the existing choice under current law: Accept federal funds for patients too poor to pay for health services, or receive nothing and leave those patients to the mercy of emergency rooms.  

And so a time for reconsideration is here. Republican Governor Nathan Deal of Georgia said his administration is reviewing its Medicaid program, looking for new “possibilities.” In Kansas, a large majority of state senators, following the lead of their colleagues in the House, have passed a Medicaid expansion bill seeking to cover 150,000 Kansans. Expansion has a new impetus in North Carolina and Virginia, as well.

States seeking to experiment with the law's Medicaid provisions, as have Arkansas and Indiana, should face few obstacles from Donald Trump's administration. But whether they opt for one-size-fits-all or seek to adapt Medicaid dollars to unique specifications, the 19 states should all recognize that the rebellion against Obamacare is over. It's time to get their people covered, and get on with it.

--Editors: Francis Wilkinson, Michael Newman.

To contact the senior editor responsible for Bloomberg View's editorials: David Shipley at davidshipley@bloomberg.net.

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