States resisted initial Medicaid program, too
The Kansas City Star
Governors said “no way.” State legislators swore they wouldn’t touch the stuff.
Federal money, that is. To pay for health care for low-income Americans.
The year was 1966 and the federal government had just enacted the original Medicaid program. Participation by states was voluntary, and leaders in many parts of the country were deeply skeptical about taking on their share of the program.
But a year after the federal matching share became available, 26 of the 50 states had signed on. Within four years, every state except Alaska and Arizona were participating in Medicaid. Alaska came aboard in 1972. Arizona yielded in 1982 after citizens petitioned the state legislature, complaining that their federal tax dollars paid for Medicaid, and they ought to be receiving some benefits from it.
Almost 50 years later, resistance to a Medicaid expansion under the Affordable Care Act runs high in many state capitals, including Missouri and Kansas. But the experience of the original Medicaid program, and also of the Children’s Health Insurance Plan, which expanded coverage to low-income children, suggests that full participation may be only a matter of time.
It’s hard to defend holding out when other states are reaping major economic development benefits from federal Medicaid payments and citizens elsewhere are healthier and more secure.
As I noted in this column, the Affordable Care Act offers a potent incentive for states to jump in quickly. The federal government will pay 100 percent of the costs of the expansion in the 2014, 2015 and 2016 fiscal years. People who have gone without insurance and then get into a plan tend to be heavy users at first. They’ll see doctors for preventive care and have long-postponed surgeries such as knee replacements. So states want to get people into their insurance networks while Washington is picking up the tab.
Republican legislators in Missouri and Kansas, and maybe Kansas Gov. Sam Brownback as well, think they can still derail the Affordable Care Act by holding out. But chances are they’ll only hurt their own constituents and their states’ bottom lines over the long run.