All eyes were glued to Washington, D.C., on June 28 as the nation waited to see whether the U.S. Supreme Court would uphold the constitutionality of the individual insurance mandate, a linchpin in President Barack Obama’s landmark health care reform act.
Fortunately, it did, but the judges threw in a curve, striking down a part of the law compelling states to increase Medicaid eligibility limits to 133 percent of the federal poverty level.
Congress could enact a law offering states federal money to expand the availability of health care, the judges said. But it could not penalize states that didn’t expand Medicaid limits by withdrawing their existing Medicaid funding.
The long-awaited court decision roiled state capitols and will continue to do so in 2013.
It meant the Affordable Care Act will become a reality, regardless of how fiercely Republican state legislators and governors push back against “Obamacare.” And it dropped two big decisions into the laps of state governments.
One has to do with health insurance exchanges, which are new organizations that will set up a more competitive and consumer-friendly market for purchasing health insurance.
The Obama administration made grants available so that states could set up exchanges and upgrade the technological infrastructure of their Medicaid programs. Missouri’s is especially archaic.
Neither Missouri nor Kansas took advantage of the opportunities, however.
Kansas Gov. Sam Brownback had earlier returned a $31.5 million federal grant. And Missouri voters in November approved a ballot measure forbidding the governor or anyone in the executive branch to move forward on an insurance exchange without consent of the legislature.
The U.S. Department of Health and Human Services is creating a federal exchange for use in states that don’t design their own. That seems like the last thing Republicans in Missouri and Kansas would want, but it is in the cards unless officials act very quickly in 2013 to meet a federal deadline for partnering with Washington.
The other big decision involves the Medicaid expansion.
Right now, it is nearly impossible for low-income workers in Missouri and Kansas to obtain health insurance if their employers don’t provide it. Both states have very low Medicaid eligibility limits. People go without care, use free health clinics, or use hospital emergency rooms.
The economic and moral reasons to expand Medicaid are compelling.
The federal government would pay all of the costs of the expansion for three years, and never less than 90 percent. Expansions of health care systems would create thousands of jobs and a huge economic development boost. Some populations who use state aid, such as the mentally ill, would be brought under the Medicaid umbrella, saving states money. People would be healthier and more financially secure.
Missouri Gov. Jay Nixon intends to include the Medicaid expansion in his budget but will face opposition from the legislature. In Kansas, neither Brownback nor legislative leaders have said how they intend to proceed.
Hospitals, citizens and states’ economies will suffer if leaders allow an antipathy toward all things “Obamacare” to deny the benefits of health security.
A more rational argument holds that states will be left with massive expenses if the federal government reneges on its commitment to bear at least 90 percent of the cost of the expanded caseload. But basing a decision on a hypothetical scenario with no precedent isn’t smart public policy.
Many states balked at joining the original Medicaid program in the 1960s, but within four years all but two had come aboard as citizens and elected officials saw the benefits other states were reaping.
The offer for 100 percent federal financing of the cost of state Medicaid expansions runs out in 2017. Leaders in Missouri and Kansas must seize a unique opportunity to repair a broken system that currently leaves hundreds of thousands of people in both states without a way to be well. If they don’t, the problems created by uninsured patients will only get worse.
Copyright The Kansas City Star. Reprinted with permission.