The Times West Virginian

May 5, 2013

Need doesn’t go away during debate about state Medicaid expansion

Times West Virginian

— The debate — fierce at times — is under way.

Gov. Earl Ray Tomblin announced Thursday that West Virginia will expand Medicaid under the federal health care overhaul, which would extend coverage to an estimated additional 91,500 uninsured, low-income residents.

The federal government has pledged to cover the entire cost for the first three years of the program. West Virginia gradually pays for a portion starting in 2017, peaking at 10 percent in 2020 and every year thereafter.

A financial analysis concluded that more than $5 billion in promised federal funds will cover nearly all of the resulting costs over the next decade. The report also calculates that West Virginia’s share of the burden during that time will increase by $375 million.

The Patient Protection and Affordable Care Act greatly expands public health care coverage. Last June, the U.S. Supreme Court ruled the act was constitutional, but mandating states to expand Medicaid coverage was not.

Tomblin was one of just two Democratic governors who had yet to choose whether to expand Medicaid, leaving Gov. Steve Beshear of neighboring Kentucky as the party’s last holdout. Seven Republican governors have pushed to expand Medicaid, including Ohio’s John Kasich. All told, 22 states and the District of Columbia are moving to expand Medicaid, while 14 have decided against it.

The federal law calls on states to extend Medicaid benefits to people who make less than 138 percent of the federal poverty line. That’s about $32,499 for a family of four. With one of the strictest limits among states, West Virginia now bars adults from enrolling if their household earns just one-fourth of that — $8,240 for a family of four.

The state Republican Party and Attorney General Patrick Morrisey, a Republican, strongly criticized the expansion.

GOP Chairman Conrad Lucas, the Charleston Daily Mail reported, questioned whether the state could afford the change.

“While paying for the state’s portion of this expansion will be daunting enough today, does anyone really believe that the federal government will maintain its same level of Medicaid funding in the future when it is staring at a $16 trillion debt and desperately needs to reduce spending?” Morrisey, a vocal opponent of the federal health care overhaul, said in a press release.

Democrats, meanwhile, defended Tomlin’s position.

“The whole reason we fought so hard for health care reform was to finally find a way for every one of our fellow West Virginians, and especially those who struggle to get by day by day, to be able to see a doctor or nurse when they are sick,” said Jay Rockefeller, West Virginia’s senior senator.

United Health System President and CEO Tom Jones, meanwhile, cited how hospitals nationwide will lose $155 billion in federal payments over the next 10 years.

“This expansion of Medicaid in West Virginia will replace a significant portion of those cuts, and keep West Virginia hospitals financially healthy to serve our citizens,” Jones said at Thursday’s announcement.

We believe Tomblin made the correct decision to go forward with Medicaid expansion.

As noted, for the next three years there is a commitment in place for the federal government to pick up 100 percent of the added costs.

As Tomblin said, the decision can be revisited after those three years are up.

It’s also important to realize that during the debate over how health care costs are paid, the need doesn’t go away.

That has meant the inefficiency and expense of continual visits to the emergency room, delayed or insufficient treatment resulting in sicker patients, uncompensated care that batters budgets of health care facilities, and patients and families forced into bankruptcy by medical costs they have no chance to repay.

“We have to understand that there’s a considerable amount of uncompensated care that’s provided in our state and that, at the end of the day, the private sector and the taxpayer pay for that,” Dr. Christopher Plein, interim director of the School of Social Work at West Virginia University, said in an interview with West Virginia Public Radio. “If folks could get into a health care system, be in a managed-care system for example or a medical home, then ideally there will be less utilization of emergency rooms and more utilization of preventative care, wellness and regular primary care.”

No one believes the early years of health care reform will be smooth. We hope, though, it can be more than a time for political battle as we come to grip with the fact that care is not “free” but we don’t say “tough luck” to the poorest and sickest among us.