Medicaid Expansion has been a hot topic among a number of states. To date, half of the states have opted to expand Medicaid and accept the federal funding. 19 states have rejected it, leaving the federal government to fill in the void some point in the future. That leaves only 6 states looking at other options, among them, Utah.
While the governor’s office has been trying to find a solution to provide coverage to the 60000 Utahn’s who fall through the cracks in coverage, many county health professionals and a contingent of legislators want the state to buy in to the expansion program laid out by the Affordable Care Act.
In the meantime, House Speaker Becky Lockhart has come up with an alternative plan that would reject federal funding completely and find the money within the state budget to provide the most basic of coverage to Utah’s very poorest. The price tag for this option would be about 35 Million to get us to the year 2017, when more options would be available in the ACA.
Since we taped the show, the governor has laid out his plan which would seek a block grant of federal funding and a waiver to set up our own plan. The heart of the program would take the federal dollars we would have received to expand Medicaid, and instead, use them to help some 100,000 Utahns get private coverage.
Our TV program this week looked at three of the four options (the governor’s had not been presented at the time) to see how each of them would impact county services that deal with behavioral health and substance abuse.
The issues for counties is that they are the last line of defense in providing care for people who can’t afford insurance, Regardless of what happens, counties will not turn people away, currently people aren’t receiving the help they need until they are further along in their illness and in many case particularly in the area of mental health care. People cannot afford the medications to stabilize their condition, often end up in the custody of the sheriff’s office, or failing to break addiction in a drug rehab program. Either way the counties end up with a greater burden on their budget and resources.
The need to address the issue, whether for impact on the counties, or simply the impact on the citizens is clear and only a few would take the stance of Marie Antoinette “let them eat cake”. We are not that heartless. The issue really is about the efficiency of the program, the reliability of the federal government to pay their share, and the tax dollars we are contributing via federal taxes, whether we use them or not. It is in this context that I will address the show. Here are the options:
Do nothing; If we cannot come to some agreement on expansion and we do nothing, some 60,000 people will be at real jeopardy for health care, and in the arena of mental health, the counties will be seeing a cost burden. To date they have been receiving federal dollars to assist in treatment via grants. Those grants are going away. Loss of that funding was part of the plan to be able to afford the cost of implementing the ACA.
Do it All: The problem with signing on to the expansion is the reputation and track record of the federal government to keep their promise to pay for things they commit to pay in exchange for our participation in their schemes and programs. Now before you criticize, just think of the many County Seat episodes we have aired on PILT, enabling acts, cutbacks in federal funding for forest management, then transferring the burden to fight the fires that result from the cutbacks to the state and counties. This is a real concern, and we should be wary of committing to something that we could be required to later pick up the federal part of the tab. Even if you dismiss that part of the argument, it is not wise to place stock in an organization that is already 17 trillion in debt and not have collateral or at least an exit plan if they fail. No bank or business partner would do it, why should the state?
Do it ourselves: Speaker Lockhart’s plan takes the above in consideration and looks at addressing the issue without federal help. It is a noble notion. The problem with this plan is not in the concept, but rather in the math. If the price tag is 35 million, and you need to cover 60,000 individuals, that works out to be 583.33 per person per year. I don’t know about you, but I am pretty healthy, and I spend that much a year on myself.
The Compromise: The governor’s plan takes most of the above into account, yet it too has problems. His plan acknowledges that we are already contributing through federal taxes, and we might as well keep it in state. HIS PLAN also figures that it would be able to actually cover more people (110,000) rather than the 60 thousand who currently lie vulnerable. It does rely on the private market, which could be a blessing or a curse. It is usually good option in the long run to engage the private sector, but if competition is too limited, it can end up having some surprises to it. Limited competition often leads to price fixing, which the insurance industry has a built in exemption to (Robison Pattman Act). The one question that is not addressed in the governor’s plan is what happens if the federal government decides not to fund it in future years, which is the same problem that is currently sparking the debate. I favor local control on any issue, so by default, it is better to be steering the ship, as opposed to only being along for the ride.
For any of these plans to work the legislature has to find a common ground and support a plan. In this analysis, the governor’s plan looks to address the most issues, but he is also challenged with not only getting the legislature on board (with only one week left), but also to get the federal government to give him the waiver.
Those are my notes on the issue, I welcome a discussion of yours.
Chad Booth