With the first Tuesday of November fast approaching, I decided to find out more about what I would be voting on. Of particular interest to me is Proposition 3 : Medicaid expansion under the Affordable Care Act (ACA). I learned about the benefits and pitfalls of the proposal, and how the ideological motives behind it clash with the practicalities of cost and politics. The facts show that while passage will indeed save lives, it is merely one step on a long, rocky road to affordable health care that many would rather not travel in the first place.   

Foremost in the facts is that the measure will only mean partial expansion. Not jumping on all the way means a relatively lower burden on the state, but at the cost of comprehensiveness which spells more time and effort later. The New York Times approached the issue in the nationwide context of states changing their own Medicaid programs. The article points to similar expansion measures in many conservative states, notable due to the degree of partisanship that still rages over the ACA. Conservatives were initially surprised with the backlash coming when they tried to repeal the nationwide measure in Congress.

The argument for is an ideological one: lives will be saved because of this. But this is only a short-term success that will be mitigated by increasing enrollment and costs without the expansion of funds. This is of the greatest concern to legislators, but there is little organized opposition to the expansion. But the ballot measure is not the only barrier to adoption; the measure must be approved by the Centers for Medicare and Medicaid Services (CMS). VoxCare in a recent article points to similar measures proposed by Massachusetts and Arkansas that were turned down. For the CMS to approve Utah’s plan, which affects a nearly identical demographic as the other plans, and not the others, would be political folly.

The rub is in the partial expansion piece. Utah is relying on its distinction from those other cases that it would expand rather than roll back coverage. Utah legislators fought hard to get where they are today, even if the measure would only help a few thousand people below the poverty line. It represents a symbolic step more than a practical one, and on that front those in favor of the measure should come out on top.

Articles can be found annotated here.

Photo by nffcnnr



CC BY-SA 4.0 Medicaid Expansion: Force and Folly by Christopher is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.


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