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Brewer And Medicaid Expansion


In the course of her (excellent, of course, read it now) analysis of Roe‘s 40th birthday, Linda Greenhouse notes another important story:

Ms. Brewer, who has become something of a conservative icon for her aggressive opposition to Mr. Obama’s policies, surprised many Legislature watchers at her State of the State address last week by saying she wanted to expand the state’s Medicaid program to include anyone who makes up to 133 percent of the federal poverty level, or $14,856 for an individual. The risk if Arizona does otherwise, she said, is losing the federal funds and the health care jobs that come with the changes.

It could be simply a case of math trumping ideology: In 2014, the first full year of the expansion, Arizona stands to gain $1.6 billion in federal matching funds, Ms. Brewer said. (The federal government would cover the full cost of the new beneficiaries in the early years and 90 percent of the cost after 2020.)

This provides some reason to be optimistic that the damage done by the Supreme Court’s limitation of the Medicaid expansion can be contained. Obviously, some states will continue to resist the expansion. But the use of the federal spending power — even when confined to new as opposed to existing spending — upends the usual politics of health care. Providers, normally the most important obstacle to reform, suddenly become a powerful voice on the side of reform. Eventually, even very reactionary state governments are unwilling to pass up federal money over the long-term — immediate complaints followed by quietly taking the funds once the issue has died down is how things usually work. The fact that the very reactionary governor of the last state to implement the original Medicaid program has to be considered an encouraging sign, although any optimism should remain very cautious until we see if she can bring the legislature along.

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  • DrDick

    This is reassuring, but I fear that far too many Republicans at the state level are either innumerate or so blinded by their hyperpartisan ideology that they will reject the expansion out of spite or ignorance.

    • JKTHs

      I’m sure that will fade, perhaps sooner rather than later, especially if/when the ACA becomes popular

      • DrDick

        You have far more faith in human nature (especially that of the teabaggers) than I do.

  • DocAmazing

    Providers, normally the most important obstacle to reform, suddenly become a powerful voice on the side of reform.

    Please don’t mistake the AMA for the voice of healthcare providers.



  • sibusisodan

    Question: can the states opt-in later on, if they change their minds? Or is this a one-time only deal?

    • JKTHs

      They can opt-in whenever they want

  • kgus

    Just for the record: Brewer, who has always been on the far right, started her governorship in a surprisingly accommodationist mode – but got so much grief from her farther-right legislative leaders that she quickly veered back to “safe” territory.

    I think (guess [hope]) that the dollars will just barely win out here, but won’t hold my breath.

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