One of the three key items that need to be resolved this year is the Medicaid expansion that is part of the federal Affordable Care Act (ACA) or “Obamacare. (The other two are the overall budget and education funding increase as a result of the McCleary decision.) The policy choices are getting clearer and clearer as we go through the session, and the support has become more substantial as the numbers work themselves out.
- We will be able to provide coverage for almost 350,000 additional people in Washington.
- The federal government will pick up the tab, covering 100% of the cost of the newly eligible.
- The expansion will save the state money, with around $250 million in savings in the first two years.
- The benefits are spread throughout the state, with the biggest impacts in rural counties with high poverty rates.
- The expansion will generate about 10,000 new jobs in Washington, and bring lots of new cash into the state from Washington DC, instead of the other way around as it usually works.
I’m pretty excited about the opportunity. It’s not often that we get to do something good and save money in the process. The cast of interest groups supporting the proposal is a little different than you would expect. Normally we’d expect to see the WA State Hospital Association, the WS Medical Association (docs), the AARP and the poverty groups like the Children’s Alliance, the Poverty Action Network, etc. support a bill like this, but the Association for Washington Business (our state’s chamber of commerce) came out today in support. A recent poll of state residents has about 2/3 supporting the expansion, and less than 30% opposed. The Seattle Times endorsed it this week.
I talk to a lot of legislators as part of my budget work, and there is a lot of support among both Democrats and Republicans, particularly among people who work on the budget and can see the numbers up close and personal. I’m hoping that we can move legislation implementing the expansion early in the remaining part of session so that it isn’t a distracting factor in the final negotiations over the budget.
One of my favorite graphics explaining the reasons for the expansion is put out by the Washington State Budget and Policy Center. Of course, the information junkies in my (vast) readership will want more detailed information. Start at the federal government’s information source on the ACA: http://www.healthcare.gov/law/information-for-you/wa.html.
There are a number of really interesting policy issues to work out about how we support some programs we’ve offered for many years that hover around our core healthcare offerings, but have not been part of Medicaid until now. We’re changing our approach and going all-in. Our belief is that someone who needs reproductive services or someone who just wants a breast cancer screening would be better off with comprehensive healthcare rather than individual uncoordinated services. We’re working on careful transition programs so that we maintain a continuum of care, but we’re converting everything to the core offerings.