When it comes to free Medicaid dollars, some governors in a state of denial

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John O'Connor
John O'Connor

Under a newly expanded Medicaid program option, states stand to reap billions of dollars in what amounts to free money. This offer comes at a time when most states are standing on shaky fiscal footing.

So you'd think every governor would be jumping at the opportunity, right? But in more than a dozen states, the answer ranges from “no thanks” to “not yet.”

That's because the freebie money is part of the new healthcare law better known as Obamacare. That puts the opposed governors (who happen to all be Republicans) between a proverbial rock and a hard place. Do they accept a lucrative offer that helps them serve the citizens of their state better but earns the wrath of a conservative base? Or do they toe the political line and essentially tell poor state residents to take a hike?

There are probably many ways to describe a thought process that would put political loyalty first here. But perhaps the main character in the movie Forest Gump summed it up best: “Stupid is as stupid does.”

For is there really any better way to depict such narrow-minded thinking? Yet, governors in these 14 states are putting poor seniors needing healthcare at unnecessary risk.

But if hand-tied politicians are entitled to their talking points, they are not entitled to their facts. Here's one to chew on: States that decline to expand Medicaid will lose out on a total of $8 billion in federal funds. Here's another: They will also leave many millions of their residents uninsured. Here's a third: They'll spend about $1 billion more on uncompensated care. Those facts aren't mine. They appear in a new study in Health Affairs by two RAND Corporation number crunchers.

The authors — Carter Price and Christine Eibner — offer some pretty straightforward advice: “We conclude that in terms of coverage, cost, and federal payments, states would do best to expand Medicaid.”

Doesn't seem like a real tough decision when you get down to it. But a surprising number of people elected to be the top executive in their state seem to be challenged by the prospect of putting first things first. Of course, they can't admit that's what's really going on. Instead, they are trying to find political cover in decrying how the feds might eventually make the deal not so good.

By the way, please don't write complaining that I'm bashing Republicans. This kind of mind-numbing stupidity transcends party affiliation. The Medicaid expansion offer on the table covers residents up to 133% percent of the poverty line. The federal government carries the full freight through 2016 and pays 90% after that. That's a lot of funding that nursing homes and other providers sure could use. Now if you as a state governor can get a better deal someplace else, be my guest. But please stop insulting what's left of my intelligence by pretending to stand on principle.

But, hey, I get it. Sometimes you have to play the game, even if the game involves keeping the base away from the pitchforks and torches. Fair enough.

But here's a simple question for all you killjoy governors to think about before you go to sleep tonight: When you took that oath of office, exactly whose interests were promising to look out for?

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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