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April 5, 2012 at 12:14 PM

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McKenna talks up Medicaid expansion, despite lawsuit

When Republican Attorney General Rob McKenna joined the lawsuit challenging President Obama's 2010 health-care overhaul, he criticized the "massive expansion" of Medicaid as a budget buster for states.

In media interviews over the last few years, he has frequently sounded similar alarms about the Medicaid provision - once even likening it to "creeping socialism."

Lawyers representing McKenna and the other 25 states challenging the law have argued the expansion is "coercive" because it would withhold federal funds from states that don't expand their Medicaid programs.

So it's been a bit jarring to hear McKenna speak positively about the law's Medicaid provision in recent weeks.

McKenna has taken to citing the expansion as a way that health coverage can be expanded even if the health-care law's requirement that most American purchase health insurance is struck down by the U.S. Supreme Court.

In an interview on TVW last week, McKenna called the Medicaid expansion "important" because it would give health coverage to more people. Earlier in the week, on KUOW, he noted the Medicaid expansion will help "expand coverage quite extensively in our state."

McKenna made the same point in an interview with me the previous week, saying "if you want to cover poor people without insurance, it [Medicaid] is the fastest way to get there."

So has McKenna changed his tune? It certainly seems like he's shifted his emphasis.

In an interview Wednesday afternoon, McKenna tried to explain his position, staking out a carefully crafted middle ground on the Medicaid issue.

McKenna said expanding Medicaid, by itself, is "perfectly constitutional."

What he and the other plaintiffs have been arguing, he said, is that state rights were violated by the health-care law because the federal government unilaterally imposed the Medicaid expansion and is threatening to withhold money from states that don't go along with it.

That amounts to "commandeering" of state budgets, McKenna said.

Under the law, Medicaid will be expanded in 2014 to cover millions more people (including adults at up to 133 percent of federal poverty level). The federal government will pay the entire cost of the expansion at first, but the feds' share will decrease to 90 percent after several years, leaving states to pick up the rest.

The Kaiser Family Foundation has estimated the expansion could cost the state $380 million between 2014 and 2019, with the federal government kicking in another $8.3 billion to cover state residents. There are currently 1.2 million people on the Medicaid rolls in Washington, according to the state. It is estimated the new law could add hundreds of thousands more.

Some of McKenna's recent comments may be attributable to realism.

Judges have been unimpressed with the legal arguments against the Medicaid expansion. Even Roger Vinson, the federal judge who struck down the health-care law last year because of the individual mandate, did not agree that the Medicaid provision was unconstitutional.

So McKenna said he's prepared to implement the expansion if elected governor, though he still has worries about the cost to the state down the road. He pointed out that he's not alone, noting that Gov. Chris Gregoire and other governors have expressed qualms about the potential impact on their state budgets.

McKenna said he backs changes to Medicaid to encourage cost effectiveness, such as moving more beneficiaries to managed-care plans.

"It needs reforms, but I think it's better to give people coverage than for them to be uninsured and uncovered," McKenna said.

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