I’ve been arguing that the states suing the federal government over the constitutionality of health care reform or nullifying reform through the state legislature are home to Americans who are most in need of health care coverage. These populations have the most pronounced instances of chronic disease and live in states that simply don’t have the tax base or political will to invest in public health care programs. Thus, they often go uninsured and their conditions only worsen.
In the newest issue of Health Affairs, Leighton Ku also points out that “paradoxically, the opposition in these states appears to run contrary to the economic and health interests of their residents”:
On average, 39 percent of the Medicaid-eligible adults in the twenty-one “opposing states” were uninsured, compared to 26 percent in the rest of the nation. Because opposing states have relatively more eligible-but-uninsured adults, their residents have much more to gain form the Medicaid expansions, and these states would draw down far more federal funding.
Given that many states are interpreting the Medicaid expansion as an unfunded mandate, Ku argues that “some states’ projections of new costs appear to be overstated,” as governors have “not accounted for factors such as the reduced costs of serving the newly eligible.” Not only would the federal government be picking up the tab for most of the expansion (meaning that states would be covering more residents at little direct and will be able “reduce payments they make to support uncompensated care costs”), but Ku says that “most economists expect the economy and employment to brighten by 2014, so there should be fewer income-eligible people and higher state revenues than today.”
Of course, the expansion and increase volume of patient needs will require plans to expand networks and states will have to take steps “to design simple application forms and procedures, including online systems, that can operate across multiple points of enrollment; to develop systems to enroll applicants in the right programs; and to share date securely across programs.”
States will have to face their share of challenges in implementing reform, but in choosing to challenge the law rather than accept it, they are placing politics ahead of sound policy, kicking the can down the road and undermining the interests of their residents.