A devil in the detail

Published 8:53 pm Friday, August 14, 2009

Democrats are having a tough time building public support for health care reform in part because millions of Americans fear the devil is in the details of the complex legislation. One such detail — a proposed expansion of the state-federal Medicaid program — would have major implications for Alabama and other states that are struggling to cover their part of the Medicaid tab.

The Press-Register reported Thursday that at least 237,000 Alabamians could gain Medicaid eligibility under a proposal in the U.S. House of Representatives. Medicaid now covers about 800,000 state residents — most of them women and children in low-income families. If Congress approves the expansion, the government-managed program would cover more than one-fifth of Alabama’s population.

This is not a welcome prospect for state Medicaid officials. Although the federal government would pay about 90 percent of the cost of the expansion, state Medicaid spokeswoman Robin Rawls said Alabama does not have the matching money. Over a decade, the state’s cost would run into hundreds of millions of dollars.

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Alabama officials aren’t alone in their concern over the fiscal impact of the Medicaid provision in the health care reform bill. The New York Times reported that the Democratic governor of liberal Washington state, Christine Gregoire, is “among a group of governors from both parties who fear the implications of the health care overhaul.”

Specifically, the governors are worried that Washington will stick their states with a sizeable chunk of the estimated $430 billion increase in Medicaid costs over 10 years.

Democrats and Republicans generally agree that a goal of health care reform should be reducing the number of uninsured Americans. There is considerable disagreement, however, over the wisdom of expanding Medicaid, which already is pro jected to cost taxpayers $600 billion a year by 2017.

—The Press-Register