OUR OPINION: Expanding Medicaid makes sense

It’s not just the fact that expanding Medicaid would bring more federal dollars into North Dakota to deliver a useful service.

It’s also the fact that refusing to expand Medicaid will cost North Dakota, maybe enough to force some hospitals and clinics to close.

Those are the possibilities Gov. Jack Dalrymple had to consider when he was putting his budget proposal together. And that’s why he was right to choose to expand Medicaid in line with Obamacare, the Affordable Care Act.

Here’s hoping North Dakota lawmakers go along.

As one of its provisions, the health care law authorizes an expansion of Medicaid, the federal/state partnership that provides health coverage for low-income people. The Supreme Court ruled that each state can decide whether to make the change.

Here are the terms: Washington will pay 100 percent of the expansion’s cost for the first three years, then 90 percent after that.

That was enough to convince Republican Gov. Brian Sandoval of Nevada, among others. “It wasn’t exactly an enthusiastic endorsement — Nevada officials warned that it could place a burden on the state budget when the 100 percent federal match starts to phase down to 90 percent by 2017 — but there was also recognition that it would be unwise to forego an infusion of federal dollars into the state economy,” Governing magazine reported.

“Sandoval’s office estimates that the expansion will enroll 78,000 people and bring more than $700 million in federal dollars into the state over the first three years.

“‘That’s a massive leverage of federal dollars,’ said Jeff Mohlenkamp, Sandoval’s budget director. ‘Considering how many federal dollars we are leveraging, the cost (of expansion) is fairly small.’”

Arizona’s Republican Gov. Jan Brewer said the same. “With this move, we will secure a federal revenue stream to cover the costs of the uninsured who already show up in our doctor’s offices and emergency rooms,” Brewer told the media.

Now, here’s the other key: Refusing to expand Medicaid doesn’t just keep things the way they are. It could make the state worse off.

“Hospitals have a big stake in expansion because the health law, anticipating fewer uninsured, reduces their federal aid for providing uncompensated care,” reports Ron Brownstein of National Journal.

“States that don’t expand coverage will sentence their hospitals to treating big pools of uninsured people even as payments for doing so fall. ‘For certain safety-net hospitals, that is insolvency right there,’ (consultant Caroline) Pearson says.”

Hospital insolvency: That’s a real-world impact. In contrast, opponents of the expansion point to more speculative fears about an out-of-control federal deficit.

But the United States has tamed deficits before, including as recently as the 1990s. Washington responds to political pressure as the economy and other factors change. That’s what elections are about; that’s where voters play the decisive role.

Right now, voters have delivered the Affordable Care Act and made it the law of the land. They’ve affirmed this through the re-election of President Barack Obama.

If the law works, it works. If it proves too costly, it can and will be changed.

Meanwhile, North Dakota can in good conscience take part.

“In the end, it comes down to are you going to allow your people to have additional Medicaid money that comes at no cost to us, or aren’t you?” said Dalrymple a few weeks ago.

“We’re thinking, yes, we should.” That’s a prudent approach, and it’s one state lawmakers should follow.

— Tom Dennis for the Herald

Tags: north dakota, opinion, updates, medicaid, health, federal, taxes