The Medicaid expansion marathon continues

Alaska has accepted the Medicaid expansion:

After failing to persuade his Legislature to expand Medicaid, Gov. Bill Walker of Alaska said Thursday that he planned to unilaterally accept the federal funds available to cover more low-income residents under the program.

Mr. Walker, an independent who took office in December, said in a news conference in Anchorage that he could not wait any longer to offer health coverage to the roughly 42,000 people his administration projects will be eligible under the expansion. Expanding Medicaid — an option for every state under President Obama’s Affordable Care Act — was a campaign priority for Mr. Walker, who couched it as a “common-sense decision” for the state’s economy and for the health of its people.

Evidently Governor Walker tried to get the legislature to support the expansion, but when those options failed, he used his power of office to do it himself. From the tone of the articles I’ve read, he appears to be acting legally. At least, I’m not seeing any legislators calling him a tyrant and threatening lawsuits.

That makes Alaska the 30th state to accept the Medicaid expansion. Many of my colleagues think that is a sign of how weakly the ACA has been implemented. Me? I think the opposite. Healthcare reform is a marathon, not a sprint. It’s important to remember that the Medicaid expansion only went into effect less than two years ago. It’s really young. Traditional Medicaid was passed in 1965, and the last state to accept it (Arizona) did so in 1982. If that same gap held true for the ACA, then we should expect the last state to accept the expansion in 2031.

Even if you accept Arizona as an outlier, all states but that one didn’t start participating in Medicaid until 1972, seven years after it began. That would be 2021 for the Medicaid expansion.

And for anyone who thinks comparing something to Medicaid is a bad example, because Medicaid isn’t as “beloved” as Medicare, remember that just a few years ago the Supreme Court ruled that traditional Medicaid was so American-as-apple-pie and essential-to-freedom that threatening to take it away from a state was unconstitutional coercion.

Healthcare reform is a long-haul process. I know many people wish that every state would just accept the Medicaid expansion right now, but that’s unlikely to happen. The good news for them is that the fact that all the states haven’t come on board yet doesn’t mean they won’t in the near future.


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