Nov 162012
 

Last week, I wrote about how many GOP-led states are declining to establish health insurance exchanges, choosing instead to cede to a federally-administered exchange. Residents of these states will still be able to purchase insurance and receive subsidies through the federally-facilitated exchange. But as Sarah Kliff explains, these states are also declining to participate in the Medicaid expansion that the Supreme Court made optional in its June ruling. Low-income people in these states will suffer as a result. They can go to the Exchange, but coverage will not be nearly as affordable as Medicaid. Hospitals and other providers will also lose out on funds to deliver what is currently uncompensated care to these individuals.

Denying access to affordable health care for what amounts to geographical reasons is both cruel and unnecessary, but those are the politics of the moment. Perhaps these states will be more inclined to expand Medicaid once bordering states do so, sparking complaints from local advocates and health care providers. Some states are pushing the Obama administration to lower the income threshold required for the expansion, but I’m not sure that diluting the law’s intent is a good idea. Medicaid is already a fragmented program with wildly varying eligibility requirements across states. Allowing states to duck that requirement would only perpetuate that fragmentation, which the Affordable Care Act was designed to remedy. An all-or-nothing expansion requirement might not help some people in the short term, but it will eventually result in a stronger Medicaid program.

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