It’s unlikely that too many states (particularly but not exclusively “red” states) will be making up their mind about Medicaid expansion before the November election.
That’s partly because the whole thing could be moot if Mitt Romney is elected, particularly if the Senate goes Republican. It’s partly because the Obama administration may not give the states all the information they are seeking before then (See this National Governors Association letter). And it’s partly because a lot of the states genuinely fear they’ll end up with the tab and they have to think hard about that.
I thought it would be useful to take a quick look at a few stories from around the country that shed light on covering the decision-making process. These aren’t the only good stories I’ve seen and they don’t explore every aspect of Medicaid expansion. Some are based on academic or advocacy reports , not a ton of on-the-street reporting. But they all raise issues worth thinking about.
Kirsten Stewart and the Salt Lake City Tribune did a nice package and clear graphics. She focused on the state’s claim that it can’t afford the expansion and compared that with data from an outside group that shows the cost per person enrolled in Medicaid was dropping – significantly. She also pointed out that the state was lumping in its own money with the large federal share as it argued that Medicaid costs were rising faster than other segments of the budget.
But the health safety net did a bang-up job, covering more people for less money than in years past, according to an analysis by Voices for Utah Children. Enrollment is projected to grow 67 percent from 2007 to 2013, but over that same period, per-patient costs actually dropped 16 percent, the report shows. Fiscal year 2013 is included in the analysis because that money has already been allocated.
An Associated Press story looked at the cost of NOT expanding Medicaid in Nebraska. It looked at the cost of uncompensated care and cost shifting, and stressed the impact in poorer, rural areas with more immigrants and few employers that provide health insurance. And it gave a passing mention to the way that the federal Medicaid money is economic stimulus – money coming into the state and creating jobs.
Elizabeth Crisp in the St. Louis Post-Dispatch does an overview of the factors in the state’s decision making – but stresses the finances of public hospitals if disproportionate share (DSH) payments were cut under the health law but new revenue didn’t come in under Medicaid expansion to close the money gap. “Nearly every hospital in the state receives DSH payments, and they stand to get a combined $784 million in DSH payments under the 2013 budget,” she writes. Losing much DSH money could endanger the financial viability of up to half the state’s hospitals.
N.C. Aizenman of The Washington Post had a very interesting story about how some Texas counties, which are already providing a lot of health care for the poor, were exploring how they could join together to proceed with Medicaid expansion and get the federal funding, even though Gov. Rick Perry has rejected statewide expansion. I haven’t seen this discussed in any other state yet but it’s something to watch for – particularly in larger states. The mechanics require all sorts of waivers and negotiations but, she writes, “Whatever the plan’s fate, it shows that frustrated local officials don’t necessarily want to give the governor the last word on whether to accept millions of federal health aid that could ease local burdens.”