The Great Medicaid Debate Begins

medicaid.jpgYou were warned: Medicaid expansion will suck up a lot of the air in Carson City this legislative session. Two months before the opening gavel, the noise has already begun.

First, though, a primer: Remember the Patient Protection and Affordable Care Act (a.k.a. “Obamacare”)? It requires everyone to have health insurance. Trouble is, not everyone can afford it. To solve that problem, Obamacare suggests broadening Medicaid, the federal health-care program for poor and indigent citizens, to include most (if not all) of these uninsured folks.

The catch is that Medicaid is funded partially by the federal government and partially by states, through a matching-funds formula—and it’s entirely state-administered. Each state gets to decide whether it wants to expand its Medicaid program; states that do will get more financial help from the federal government, which will subsidize 100 percent of the health-care costs of the expansion for the first three years, 2014-16 (states will have to cover their own administrative costs).

States that don’t participate won’t get the extra funding. In Nevada, that would mean nothing changes from the current situation. The estimated 70,000-plus impoverished adult Nevadans who now have no insurance—but could with the expansion—would be on their own.

Opting out would be a big mistake, say 15 of the state’s medical trade associations and hospitals, including major players such as the Nevada State Medical Association and University Medical Center. Their representatives recently gathered in Las Vegas to formally encourage Gov. Brian Sandoval, the Legislature and Nevada citizens to support Medicaid expansion.

“This is the right thing to do for the health of our citizens and the health of our economy,” said Ron Kline, a pediatric oncologist and president-elect of the Southern Nevada Medical Industry Coalition.

There are some compelling financial arguments for opting in. University Medical Center incurs a quarter-billion dollars a year in uncompensated care for poor and indigent patients—many of whom would qualify for Medicaid under the proposed changes, said UMC CEO Brian Brannman.

“Why would this be something we don’t want to support?” he asked.

Well, critics answer, for one thing, there are the unknown administrative costs, which the state would have to shoulder. They also say Medicaid doesn’t work well as it is, reimbursing doctors at rates too low to compete with private insurance and causing patients in need of specialty care to wait too long for appointments. Why expand a program that’s in need of reform, they ask.

Is your head spinning yet? Get used to it. There’s a lot more discussion to come.

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