In Health Care Ruling, Vast Implications for Medicaid
ENGLAND, Ark. — As a construction worker and logger, Bryan L. Mashburn does what he describes as “backbreaking, muscle-pulling work,” laying concrete foundations for water towers and felling 3,000-pound trees. He has no health insurance, and he tried to avoid going to doctors when he crushed a finger on one occasion and metal shavings flew deep into his eye another time.
[Bryan Mashburn, shown in Beebe, Ark., is among those who stand to benefit from Medicaid changes. He has no health insurance.]
Mr. Mashburn, 39, is exactly the kind of person who stands to benefit from changes in Medicaid scheduled to occur under the new health care law— a vast expansion of the program that is expected to add 250,000 people to the rolls here in Arkansas and 17 million across the country.
The expansion of Medicaid — if it is upheld by the Supreme Court — is among the most significant parts of the law, as it will provide coverage to people with the greatest financial needs. Many health care advocates support the expansion, saying it will allow poor people to receive needed care, while many state officials, especially Republicans, worry that it will bring budget-breaking new costs.
The expansion may also strain the health care system, given the shortage in some places of primary care doctors, who will be vital to expanded coverage.
Arkansas illustrates not only the potential benefits but also the major challenges facing states as they plan for a larger Medicaid program. The state does not have enough doctors and other health care workers to care for all the new beneficiaries, experts say, and state officials worry about the costs.
“The expansion of Medicaid is a sea change, and it’s occurring at the most difficult fiscal time in the history of the program,” said the Medicaid director in Arkansas, R. Andrew Allison, who is the president of the National Association of Medicaid Directors. “States are preoccupied with the challenge of sustaining the Medicaid program we already have.”
Arkansas officials have discussed cutting Medicaid services in the coming year to help close a gap between Medicaid costs and expected state appropriations. The gap — up to $400 million — represents more than one-fourth of state spending on the program.
Medicaid is jointly financed by the federal government and the states, with Washington paying 50 percent of the costs in higher-income states and about 70 percent in lower-income states like Arkansas. States have historically had leeway to define eligibility and benefits within guidelines set by federal law.
Under the new law, the federal government will pay the full cost of covering those newly eligible for Medicaid for three years, from 2014 to 2016, and the federal share will then gradually decline to 90 percent in 2020 and later years. Administration officials say this is a good deal for states, but it may ultimately create new costs for states. Many state officials also worry that Congress will reduce the federal share and shift more costs to the states.
“There is uncertainty, very commonly conveyed to me by states, that the law as written now will somehow have to change to address the federal government’s fiscal crisis,” Mr. Allison said.