California vs. Texas: The Jekyll and Hyde of health-care reform
So Texas is making noises about ditching Medicaid, but on the other end of the spectrum, some blue states are rushing to embrace the program's expansion under the federal health-care reform law as quickly as possible. Take California, for example: Just last week, the Obama administration approved a plan that will give the state $10 billion to modernize and expand the state's Medicaid program. The plan -- which was passed by the state legislature and heralded by Gov. Arnold Schwarzenegger (R) -- will expand coverage to about 500,000 Californians who didn't previously qualify for Medicaid. All states will be required to undertake a similar entitlement expansion by 2014, but California is leading the pack.
Why is California so eager to get ahead, while red states continue to drag their heels? The state had already made an effort to insure poor residents who didn't qualify for Medicaid, requiring counties to take final responsibility for covering the poor, disabled and low-income seniors. As a result, county governments and hospitals for low-income residents have extended health-care services, if not full insurance coverage, to a larger swath of California's population. But county governments have struggled to come up with the funds for such services: The Los Angeles Department of Health, for example, is facing a $629-million deficit from last year and this year. California counties and hospitals will now receive federal funds to transition their low-income patients into a full Medicaid coverage program: Los Angeles County will receive $65 million more in revenue, for example, and California is expected to pay only 1.5 percent more for Medicaid, while the federal spending on the program will rise by 23 percent.
Earlier during the debate, Schwarzenegger had joined Texas and other states in protesting the Medicaid expansion as a budget-buster. Now he's outright celebrating some of the changes under health-care reform for providing an injection of new federal money. "This agreement is great news for the people of our state because we will be able to expand coverage, improve the delivery of care and build a strong bridge to federal healthcare reform with increased federal resources," he said in a statement Tuesday.
Having committed to extending health-care services to more of its population, California has decided that it's worth betting on health-care reform and reaping the benefits of federal dollars sooner than later.
Texas stands to receive even more bang for its buck in the Medicaid expansion -- at least partly because the state has restricted its Medicaid eligibility and skimped on its benefit packages for so long. As a Kaiser study points out, the federal government will be covering more than 95 percent of the costs of the state's Medicaid expansion: "If Texas sees a 46 percent increase in Medicaid enrollment by 2019, the study notes, it will still only see state Medicaid spending grow by 3 percent," reports the Texas Tribune. In essence, the residents of some states that have done the least to expand medical coverage are now poised to benefit the most from health-care reform.
On one side, you have states such as California that made expanding health-care to the poor a priority well before the passage of the federal health-care reform law -- and those states are now grateful to receive federal money to assist their efforts. On the other, you have states such as Texas that declined to make this commitment and now resent that the federal government is forcing them to do it.
| November 11, 2010; 6:17 PM ET
Categories: California, Government, Health, Health Coverage, Health Reform, Obama administration, states
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