The Washington Post has an interesting overview of how the generosity of states’ existing Medicaid program is affecting their response to the new health care law. Of course everything will depend on how many people actually sign-up for Medicaid and whether the federal government will maintain its funding commitments, but generally speaking, states that have wider eligibility rules will receive more federal Medicaid dollars than those with narrower provisions:

Starting in 2014, anyone making up to 133 percent of the federal poverty line — now $14,400 for a single person and $29,300 for a family of four — will qualify for Medicaid under the new law.

The requirement will affect states differently depending on the generosity of their existing Medicaid program. Virginia enrolls only the blind, disabled, some needy children and deeply indigent parents who make up to 24 percent of the poverty line. State officials have estimated that boosting coverage to the required level means as many as 426,000 people might become part of the program, which includes about 837,000 Virginians.

The change will result in fewer new Medicaid patients in Maryland, which extends some form of coverage to most residents making up to 116 percent of the poverty level. It will have to provide more robust benefits to about 112,000 residents, but state officials estimate that Maryland will have to extend entirely new benefits to only 21,000 — less than one-twelfth the number Virginia faces.

But both states might be engaged in wishful thinking when it comes to residents who are newly eligible for Medicaid. Maryland’s estimate assumes that far fewer than the number eligible will join the program — which matches experience. Virginia’s estimate assumes about 270,000 newcomers to Medicaid, the most conservative of several enrollment models.

This is all very interesting to think about and one wonders if states will actively encourage the eligible expanded population to enroll in the program. Theoretically, states have an incentive to enroll less people and consequently spend less state dollars on Medicaid. Over time, the federal matching fund will decrease and states will have to cover a higher percentage of the cost for the expanded population and so they could be encouraged to launch a massive campaign beginning in 2014, when the federal matching rate is at its highest. Since most applicants stay in Medicaid temporarily, the long term costs of the expanded population may be of lesser concern.

The article goes on to note that the “savings” from the expanded Medicaid provision (in terms of less state spending on uncompensated care) are “fuzzy” and for now states will be busy performing a cost benefit analysis for the new spending requirements. But as we move forward, some states will grow accustomed to spending more money on health care and these kinds of expenditures won’t be seen as too controversial. Or, alternatively, the federal government will step in and provide some extra funds to prevent states from limiting eligibility.

Marco Rubio is now backing away from his claim that he would preserve certain provisions of the new health care law. But as his campaign released a statement clarifying that he “believes the health care law should be repealed – all of it,” the National Review’s Jim Geraghty posted this video of Rubio clearly articulating his support for maintaining provisions that eliminate the pre-existing conditions exclusion and permit children to stay on their parents’ plan up to age 26:

RUBIO: Obamacare should be repealed. It’s going to bankrupt America…..So I think there are a couple of things that stand on their own that people like, like the pre-existing condition clause, I think there’s widespread support for. The idea that people up to the age of 26 should be allowed to stay on their parents’ insurance plan, has widespread support. But beyond that, I think the bill should be scrapped and replaced with much better ideas….

MATT LEWIS: So you wouldn’t scrap the ability for insurance agents — you said there were to — you wouldn’t scrap pre-existing conditions, you would keep that in?

RUBIO: Yeah, and I think there’s broad support for that, Republicans and the American public support that. And I think there’s support for the idea that 26 years old — up to age 26 years of age should be allowed to buy into their parents’ insurance plan. Beyond that, I think Obamacare is unaffordable….So I think we need get rid of these other provisions of Obamacare completely and replace them with these simpler, cheaper, better ideas.

Watch it:

In his ‘clarification,’ Rubio argues that he would replace the entire health law with legislation “establishing universal access programs to guarantee access to affordable health care for those with pre-existing conditions” and touts the House Republican alternative (which included this concept) as a model. But that GOP plan (as opposed to their 1993 proposal) wouldn’t actually prevent insurers from denying coverage based on pre-existing conditions. It relies on state based high-risk pools — and that’s very different than the pre-existing conditions exclusion Rubio supported yesterday.

Under “universal access,” (and according to the bill the GOP House leadership introduced), insurers can continue denying coverage for pre-existing conditions but states are required to establish high risk pools to insure those who cannot find coverage on their own. The bill abolishes waiting lists and specifies that the pools must provide at least two coverage options, one of which must be a high deductible plan with HSA. Premiums can be set at no higher than 150% of (state) average and the federal government will provide $15 billion in funding — a paltry sum, considering that very sick people are very expensive to insure. In fact, just recently, Republicans penned a letter to HHS complaining that the health care law’s $5 billion appropriation to run high risk pools for just 3 years is insufficient, do they really think that states can stretch $15 billion over 10 and buy insurance for all those who need it?

Rubio is trying to conflate “universal access” with an outright ban — the kind that he supported yesterday afternoon. But the two are not the same, and if Rubio really wants to prevent insurers from excluding chronically ill patients, he’ll have to support the individual mandate.