Washington state must be cautious in expanding low-income health care

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Washington state’s fiscal problems seem to have stabilized. The Legislature has trimmed spending to the point it appears there will be enough revenue to pay the bills.

But that could quickly change next year if the state opts to expand Medicaid coverage for low-income people under the new federal health-reform law.

Democrats and Republicans are sharply divided on the issue, Daily Olympian political reporter Brad Shannon wrote. The focus of the debate, according to Shannon, is how far the state should go in providing taxpayer-paid health care. Lawmakers held a work session on the topic in Olympia last week.

Medicaid now serves nearly 1.1 million Washingtonians. It’s possible another million more could enroll in January 2014 under the federal Affordable Care Act, although the state’s health director believes those numbers are too high.

Doug Porter, director of the state Health Care Authority, told a joint House-Senate committee hearing that projections show new enrollment is likely to be closer to 328,221, and he believes any new costs may be offset by savings from better-managed cost and shifting some current state costs to the federal government.

“It may be a wash,” Porter said at the three-hour session. Shannon reported that Republicans on the committee were skeptical.

“The more you talk, the nervous-er I get,” Republican Sen. Linda Evans Parlette of Wenatchee told Porter at one point in his presentation.

Parlette and other Republicans said they were also concerned about the impact this might have on rural hospitals.

These are valid concerns.

The huge budget shortfalls in the state budget have been driven by rising costs in health care and social services.

In 2011, for example, the state estimated it would have to spend 7 percent more over the next two years while trimming what it spends on higher education in real dollars (not adjusted for inflation) by at least 8 percent.

The real increase in spending was in social or human services — over a 12 percent boost over the previous budget.

In the months that followed the estimated costs for health care and other human services rose far beyond projections and the revenue projections fell short, which forced the state to limit eligibility in the state health-care program.

We see a similar scenario in the future if the state becomes too zealous in expanding Medicaid. The federal government cannot be counted on to fully support its mandates. That’s been the history.

The state’s economy has not yet recovered from the Great Recession and the state budget remains fragile.

Washington must follow the law but also be cautious in accepting more health-care responsibilities than is required.

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