At a press conference in Olympia today, Gov. Jay Inslee, a veteran of the 2010 health care reform debates in Congress, said it was "time to put away the arguments of yesterday" and expand Medicaid coverage.
Obamacare, or the Affordable Care Act, calls for a major expansion of Medicaid; the ACA removes current Medicaid eligibility guidelines which dictate that, in addition to being poor, recipients also must have other disadvantages, such as being disabled, being pregnant, or having kids.
The new ACA standard? You simply need to be poor. Moreover, the definition of poor got ratcheted up to 138 percent of the federal poverty level, or $26,000 for a family of three. (Previous income requirements differed according to various eligibility categories, but 138 is a more liberal average across the board.)
When the Roberts Supreme Court gave the green light to federal Obamacare last year, approving, for example, the constitutionality of the health care mandate and signing off on the health care exchanges, they simultaneously added a conservative footnote, deciding the Medicaid expansion provision was up to the states because states pick up some of the tab.
That tab is what has put the Medicaid expansion piece up for debate in Olympia. "Regrettably," Inslee said this morning, "I've heard comments from some of my Republican colleagues [in the legislature] that they don't want to effectuate a change."
Even though the ACA promises 100 percent federal funding of Medicaid expansion through 2016, it gradually ratchets down to a 90/10 federal/state split by 2021. Republicans—and Sen. Rodney Tom (D-48, Medina), the senate majority leader—have two concerns about the (pretty decent sounding) 10-cents-on-the-dollar deal.
1) They worry that the feds will change the deal, loading more of the burden on states, to say, a 50/50 split like the payments on existing Medicaid. And 2) Ten percent of the cost of covering 261,000 people—the number of newly eligible recipeints in Washington state—is still a lot of money. (The existing Medicaid pool of about one million, which the feds and the state split at 50/50, costs the state about $4 billion per biennium. This coverage is mandated and the tab, already part of our state's non-discretionary budget, will remain in place.)
Inslee, however, said expanding Medicaid for more than 250,000 was a "no brainer" because "it's not debatable that this is a clear and present savings." Inslee also noted that Republican governors in states such as Ohio were moving to expand Medicaid because they recognized it was a winning deal for states.
He's right about the savings. The state's existing health care services—such as the state's $100 million bill for the Basic Health Plan and the Disability Lifeline—would now be subsumed into federally funded and expanded Medicaid. That change would save the state $225 million in the 2013-15 biennium.
Inslee actually puts the net savings at a lower amount, $140 million—because Medicaid expansion or no Medicaid expansion, the ACA's insurance mandate will put 82,000 people who are eligible under the old rules, but simply haven't applied before, on the state's books at about $85 million. ($225 million minus $85 million is $140 million.)
The net impact of savings over time (from things such as the $225 million in this biennium) vs. the state's Medicaid bill (going from paying zero to 10 percent of costs by 2021) is $200 million between 2014 and 2021, according to the lefty Washington Budget & Policy Center.
Budget & Policy Center researcher Kim Justice summarizes: "Even though the state picks up 0.9 percent of costs, savings outweigh those costs by $200 million over that time period."
As for the GOP concern that the 90/10 split is tenuous, Inslee pointed out that "states are free to leave the program" at any time. And he simply didn't want to turn down the money now, noting that the $140 million savings was already booked in the state budget.
While Medicaid was the big topic at today's Inslee press conference, there were some other highlights:
• Inslee reiterated his support for the Reproductive Parity Act, which mandates that insurance covering maternity care must also cover abortions, and also noted his opposition to Sen. Don Benton's (R-17, Vancouver) parental notification bill, saying Washington voters have made their pro-choice position clear and that this was an "ideological war that should be well behind us."
• He shot down state Sen. Ed Murray's (D-43, Capitol Hill) capital gains tax idea, even as a cautious referendum to the people. "With respect to Sen. Murray, it's not [an idea] I share. I have a different direction."
Inslee didn't offer any specifics about his "different direction," though, and used the opportunity to reiterate his pitch for Medicaid expansion by noting the $140 million savings. Asked if he would dedicate those savings to education funding, he wouldn't say.
• He criticized the Republican-controlled senate for passing workers' compensation reforms this week, saying they "reduced protections for workers and their families." (We've written a lot about the GOP bills, which would allow workers to take one-time settlements over ongoing comp fund payouts. Start here to follow our coverage.)
• Inslee was also skeptical of any legislation that would change the terms of voter-approved I-937, the renewable energy mandate on utilities. (Though he was a congressman in 2006 when the initiative passed, Inslee spent an unusual amount of time and clout advocating and fundraising for I-937.) Some legislators want hydroelectric power to count as a renewable resource.
Inslee was careful to praise hydro power, but noted that upgrades to hydro are already allowed under the mandate and added that he didn't want to "remove the incentive to make investments in [new] clean energy [technology]."