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Originally published January 31, 2013 at 4:25 PM | Page modified February 1, 2013 at 8:15 AM

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Medicaid expansion: Do the math

Bipartisan support in Olympia can expand health coverage for thousands of Washington residents and save hundreds of millions of dollars.

Times editorial columnist

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A key piece of the federal Affordable Care Act is an opportunity to extend health insurance to millions of working Americans who need coverage but cannot pay for it.

Expanding Medicaid to help more low-income people could pick up an estimated 16 million of the 48 million Americans without health insurance.

Lawmakers in Olympia have an opportunity to save upward of $225 million and provide an estimated 250,000 Washington residents with access to medical and hospital care.

The federal government will pick up 100 percent of the cost for newly eligible adults for three years. The federal-state split is slowly reduced to 90-10 by 2020 and thereafter. Washington’s current match rate is 50-50.

Not a single Republican in Congress voted for the Affordable Care Act in 2010, and a partisan reticence to embrace the plan continues. But lately, some of the country’s most conservative governors have found the arithmetic too compelling.

Topping the list of those having a change of heart is Arizona Gov. Jan Brewer. The other GOP leaders who now support Medicaid expansion are Gov. Jack Dalrymple of North Dakota, Gov. Susana Martinez of New Mexico and Gov. Brian Sandoval of Nevada.

Each of the governors had to admit the opportunity could not be ignored. Ideology is no defense against uncompensated medical expenses. Their rural hospitals and clinics are stretched thin, as in Washington. State budgets stand to save extraordinary sums.

A study in the New England Journal of Medicine looked at common themes among governors for opposing and supporting Medicaid expansion.

States want more flexibility and freedom from government oversight, and they expect the federal government will renege on funding.

State Sen. Mark Schoesler, R-Ritzville, a Republican leader in Olympia, echoes the same doubts. He is still frustrated by past attempts to get waivers from Medicaid administrators, and he worries about the federal government promoting expanded coverage, then scaling back on financial support.

Schoesler does not say he opposes Medicaid expansion, but that moving ahead “requires a thorough, thoughtful decision.”

How the Republican-controlled Senate with its Demo-default majority will deal with health care has been a worry since the Majority Coalition Caucus was announced late last year.

Expansion opens Medicaid coverage to individuals making 133 percent of the federal poverty level, up to $14,850. The effective income level will be 138 percent based on the federal Modified Adjusted Growth Incomes formula. The gift of the MAGI is to disregard about 5 percent of income.

Among uninsured adults, 47 percent have income below the federal poverty level, according to a report by the Kaiser Family Foundation.

Expanding Medicaid helps get medical benefits and coverage to wage earners who are helping pay the cost of Medicare but cannot afford to buy insurance for their own needs.

Washington state has set the pace in preparing to make the Affordable Care Act a reality. One important feature is the creation of health-benefit exchanges that give residents access to one-stop shopping for insurance coverage.

Many states have chosen to let the federal government do the work. Washington’s exchange will open for business in the fall, looking ahead to coverage in 2014. State Sen. Karen Keiser, D-Kent, played a key role. She points to the 11 insurance companies that have registered with the Washington Health Benefit Exchange.

Keiser sees price-lowering competition in those numbers that should appeal to her Republican colleagues.

Helping families and small businesses buy health insurance, and maximizing coverage through Medicaid expansion, will keep more Washington residents and employees healthy.

Lance Dickie's column appears regularly on editorial pages of The Times. His email address is

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