The Affordable Care Act is titanic, a complex, far-reaching mandate that will reshape health care delivery in the United States. The promise of enhanced access and preventive care was the force that through Congress drove the Affordable Care Act’s passage. Now the parts fall together, and the Washington Legislature must act to secure Medicaid expansion.
Last year, the U.S. Supreme Court, in upholding the Affordable Care Act, ruled that states may determine separately whether to participate in Medicaid expansion. The move, which saves the state $225 million in the 2013-15 biennium, will allow 250,000 more Washington residents to receive health care. (That number will swell by an additional 100,000 by 2020.) Beneficiaries include the 20 percent to 29 percent of Snohomish County residents now uninsured. In less prosperous counties such as Clallam, Grays Harbor and Yakima, that figure is closer to 50 percent.
The centerpiece is preventive care, services that preempt or treat chronic conditions such as high blood pressure and diabetes. Cancer screenings, mental health services and vaccines all qualify as preventive care and all provide approaches to save the state and Washington families money.
Providers laboring in the trenches experience the consequences directly. Dr. Greg Sanders, a family physician and the clinical director of the Sea Mar Community Health Center in Marysville, treats mostly uninsured patients, many of whom would benefit from preventive medicine. As Sanders notes, a common-sense approach will save Washington time and money over the long-term. The message is echoed by Gustavo Ramos, Jr., an advocate for AARP whose public service career revolves around affordable housing. Baby boomers not yet eligible for Medicare (read: those 50 to 60 years old) are especially vulnerable if they’re laid off, disabled or providing for a dependent. Not surprisingly, the AARP supports full Medicaid expansion in every state.
Expansion is something of a misnomer. While services extend to the previously uninsured, including those currently eligible but not enrolled in Medicaid, the federal government is picking up the cost. In practice, state expenses would be higher if Washington opted out, and few states are giving that serious consideration. The $1 billion in federal funds in the first biennium will likely generate thousands of Washington jobs, even after factoring for state hospital reductions.
By 2020, the 100 percent federal funding level will drop to 90 percent, with Washington paying 10 cents for every dollar. Even then, expanded coverage will be a bargain, saving money, greater access, creating jobs. The Legislature should act quickly to ensure full Medicaid expansion.