States Use Federalism to Protect Poor
This commentary first appeared on Forbes.com
The fifty states are divided on the question of whether to expand Medicaid under the Affordable Care Act. Twenty-one states have so far refused to join the expansion, compared to twenty-three that have taken the opposite path. A further six are still debating whether to toss their hat into the expansion ring-including my home state of Pennsylvania.
The debate in the Keystone state looks to be ending, however. In the past few weeks, legislators in this traditionally purple state voted against expanding the program as part of the annual budget.
Governor Tom Corbett has successfully pointed out that the debate over expansion is ultimately a debate between political expediency vs. economics and morality. The former counsels Medicaid expansion; the latter shows it to be a bad move for the state’s working poor as well as its taxpayers.
The most obvious argument against Medicaid expansion is Medicaid itself. Decades of academic research point to the program’s poor track record of helping the working poor. Whether it’s Medicaid patients’ higher chances of re-occurrence for many types of cancer, their higher in-hospital mortality rates for strokes, heart attacks, and pneumonia, or their limited-and sometimes non-existent-options for many medical procedures, Medicaid has proven itself incapable of giving patients the care that they deserve-and too often, the care that they desperately need. Indeed, one in three doctors won’t take Medicaid patients, illustrating the difference between a government-provided insurance card, and actual health care.
Unfortunately, such a harsh indictment of Medicaid hasn’t stopped politicians on both sides of the aisle from pushing for its expansion instead of pursuing reforms that will better serve the working and non-working poor. What’s luring them in is the promise of “free” federal money.
This same promise has broken the wills of other politicians who at one time opposed either Medicaid expansion or the Affordable Care Act as a whole. This list includes Arizona’s Governor Jan Brewer as well as Ohio’s John Kasich, who have both gone to great lengths to push expansion in their states. Yet once state lawmakers saw the devil in the details, as they did in Pennsylvania, they strongly resisted this push to expand the broken program.
Accepting this bribery is a short-sighted move, at best. Past experience should have taught states that Washington doesn’t see its promises as set in stone. In fact, President Obama has already proposed, twice, cutting the federal reimbursement of state Medicaid costs-the very promise that has enticed several states to jump on the expansion bandwagon in the first place.
If or when this happens-and it seems an inevitable, given the growing federal debt-then a state’s taxpayers will be left holding the bill. Compounded with the ACA’s $500 billion price tag–a cost equal to $6,300 per family– the funding shortfall becomes a specter looming over the country’s families.
Thankfully, states like Pennsylvania have, by refusing to expand Medicaid, helped reduce the federal deficit by an estimated $459 billion.
These lawmakers’ steadfast refusal to throw their states’ neediest citizens and taxpayers under the bus offers a lesson in statesmanship in an era of politicking. The promise of free federal funding may seem too good to pass up now, but the suffering people will experience from a Medicaid expansion should not be forgotten so easily.
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Matthew J. Brouillette is president & CEO of the Commonwealth Foundation (CommonwealthFoundation.org).