All too often, I find myself spending my days meticulously deconstructing the criminally duplicitous arguments of politicians and public figures whom I dislike instead of searching for the kernel of goodness that lies within each and every one of them (Rush Limbaugh excepted). I do this for reasons too numerous and pedantic to expound upon without risking losing my readership, suffice it to say that high on the list are the sheer volume of jackassery in Washington that is peddled as considered policy and the fact that’s just more fun. However, in the spirit of bipartisanship and compromise, I would like to take a moment to legitimately and earnestly thank Arizona Governor Jan Brewer. While I may disagree with her immigration policies that treat hispanic Arizonans with the same decency given Jews in the Third Reich before the war and while I take umbrage with her hiring of lobbyists from the Corrections Corporation of America for positions in her administration, I wholeheartedly support the sensible healthcare strategies that the governor laid out in her State of the State address on Monday night.
During her annual speech to the Arizona legislature and her constituents, Gov. Brewer announced that she would agree to the expansion of her state’s Medicaid program as a part of the healthcare overhaul put forth in the Affordable Care Act, or as it’s colloquially known, Obamacare. Brewer became just the 3rd Republican state governor to verbally commit to Medicaid expansion, joining fellow Southwest governors Brian Sandoval of Nevada and Susana Martinez of New Mexico. What makes this latest announcement so crucial is that unlike Sandoval and Martinez, who are the governors of Democratic-leaning states, Brewer is at the helm of quite possibly the most unhinged and uber-conservative state west of the Ozarks. If a diehard daughter of Goldwater is willing to sign up for Medicaid expansion, than it provides a glimmer of hope that other red state governors may follow suit.
So, what exactly did Governor Brewer agree to? Well, the way that Medicaid used to be set up was that it was only available to certain categorically eligible groups like the disabled, the elderly, children and pregnant women. Childless adults were considered ineligible, but parents were able to receive Medicaid based on the guidelines set forth by the state in which they lived. As could be expected, giving individual states free rein to determine eligibility thresholds is going to result in a large cross-section of policies ranging from the generous to the Dickensian. The thresholds for working parents were generally higher than for non-working parents, but how anyone could be both employed and eligible for Medicaid in many states is a mystery. The average Medicaid threshold for working parents in 2009 was 64% of the Federal Poverty Level (FPL), which amounts to about $7,150 a year for a single mother or father. This meant that the most any single parent could work was around 20 hrs/wk at a job paying the Federal minimum wage of $7.25 before they became ineligible for Medicaid. Of course, that 64% number is simply an average. Some states like Connecticut, Maryland and Rhode Island gave their impoverished populations a legitimate chance to provide for their family while receiving Federal healthcare, raising their threshold for working parents to 250% of the FPL (about $28,000/yr). Other states like Alabama, Arkansas and Louisiana made Medicaid for working parents an impossibility, placing their threshold at around $2,800/yr.
The Medicaid system that Governor Brewer has agreed to implement in her state starting in 2014 is much more accommodating and much simpler than the one that is in place now. Instead of placing a Federal minimum threshold at 100% of the Federal Poverty Level, Obamacare will raise that number up to 133% or roughly $15,000/yr for a single parent. In addition, all of the special population eligibility requirements are being thrown out of the window so that ANY American making under $15,000/yr will be eligible for Medicaid. Now, if this sounds far-reaching and staggeringly expensive, it’s because it is. If every state implemented Medicaid expansion, the end result would be an extra 21.3 million insured Americans at a cost of a little over $1 trillion between the beginning of implementation and 2022. With such a Brobdingnagian price tag, it shouldn’t come as a shock that many fiscal conservatives would balk at committing to such an endeavor, which begs the question: why have Jan Brewer and two other Republican governors agreed to sign on?
Well, Brewer’s decision might have something to do with the fact that for the first three years of Medicaid expansion, the Federal government has agreed to pick up 100% of the tab, with that amount slowly declining until it reaches its projected permanent configuration, which has the Fed still paying 90% of the cost. According to a Kaiser Family Foundation study, the states would be responsible for $76 billion of Medicaid expansion costs over the next decade, which is only a 2.9% increase over what states would have paid had health care reform never passed. For Gov. Brewer, this translates into $7.9 billion in Federal funds over the next four years that will insure an additional 300,000 low-income Arizona residents become insured with almost no change in her state budget. Understandably, being the fiscal hawk that she is, Brewer made it clear in her State of the State address that she would be implementing a number of “circuit breakers” in the state Medicaid law that would automatically shrink enrollment should the Federal government reduce their promised subsidy levels. It is a minor concession that enables her to push through such unpalatable legislation while still placating the rabid Republican representatives that would rather have their legs amputated than endorse Obamacare. Whatever makes the pill easier to swallow.
Sadly, Jan Brewer is the exception and not the rule. While three Republican governors have voiced support for Medicaid expansion, ten more have stated in no uncertain terms that they will not be implementing Medicaid expansion. The governors of Alabama, Georgia, Idaho, Louisiana, Maine, Mississippi, Oklahoma, South Carolina, South Dakota, and Texas have all flatly rejected the health care reform, despite the fact that studies have shown that they will ultimately spend just as much money rejecting Medicaid expansion as they would implementing it. Not surprisingly, all of these states besides Maine, who is quickly making a name for itself as the black sheep of American politics, have current Medicaid laws on the books setting income eligibility thresholds below the Federal Poverty Line. Of the bottom 10 states according to the United Health Foundation’s overall health rankings, 6 of them are among those states refusing Medicaid expansion, including Mississippi and Louisiana, who tied for dead last. Based on the unconscionable negligence and stubbornness of their elected officials, it looks like they’ll be staying down there for a long, long time.