States still debating Medicaid expansion

The Supreme Court’s surprise Affordable Care Act ruling, stating that the U.S. government couldn’t tell states to participate in Medicaid expansion or risk losing funding for the program altogether, has divided states into three categories, according to Governing magazine: states that have embraced expansion; states such as Louisiana that have thus far rejected it; and states that still are divided. Texas Gov. Rick Perry’s argument against expansion, cited by Governing, is similar to Gov. Bobby Jindal’s: It would cost too much and overburden a federal/state program that already is approaching insolvency. “The [Affordable Care Act] remains a flawed piece of legislation that fails to fix the fundamental problems in the United States health care system,” says Bruce Greenstein, Louisiana’s top health care official, in a letter to U.S. Department of Health and Human Services Secretary Kathleen Sebelius. The feds plan to cut Disproportionate Share Hospital payments that offset the cost of treating uninsured patients; the Medicaid expansion is supposed to cushion the blow. David Hood, a former secretary of the Louisiana Department of Health and Hospitals, says Louisiana—which is attempting to move away from a charity care system based on public hospitals—would be one of the biggest beneficiaries of Medicaid expansion. Some observers expect most states eventually won’t be able to resist a huge injection of federal money. Governing reports that when Medicaid was established in 1965, only half of the states initially participated. But within the next few years, 49 were on board. Arizona held out until 1982.