State dollars should help Medicaid expand

By The Des Moines Register

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Many Iowans can probably agree with the following: A civilized country should make sure its poor residents have access to health care. Doing so costs money. Disagreements ensue when trying to figure out where that money will come from.

Gov.-elect Terry Branstad is concerned about the money that will come from Iowa to implement a provision in federal health reform law that expands Medicaid eligibility.

After the new Medicaid rules go into effect in 2014, about 100,000 Iowans will be added to the government health insurance program for the poor. That means about one in every six Iowans will be insured through Medicaid programs. The expense sounds scary to states, which share the cost with the federal government.

But it is not as threatening to state budgets as some critics are making it out to be - and there is time to plan for it. The first two years, the federal government will pay the entire cost for those who join due to the expansion. After that, it will pick up 90 percent of the cost.

That is much more than the current federal match. Newly enrolled Iowans will not cost the state nearly as much as today's enrollees. And previously uninsured people will be able to visit health providers and get help managing illnesses.

What is the alternative?

Paying for all health care for the poor with federal dollars? That's the public's money, too.

States forget that. There is a tendency to treat money from Washington as if it isn't our money.

States are always looking for ways to wring as many dollars as possible from the federal government. Get this or that grant. Secure more matching dollars for programs.

That's understandable when states have to balance their budgets while the federal government can just keep borrowing. But it's misguided thinking if you consider the bigger picture. More federal spending drives up the deficit - which is everyone's problem, no matter what state they live in.

Ultimately, paying to insure the poor is mostly funded by federal dollars, and will continue to be in the future. The Medicaid expansion is an important part of health reform. It will help about 19 million Americans get insurance - finally. It's something this country should celebrate after leaving so many Americans without coverage for so many years.

Iowa's share of the cost of expansion is doing our part with public dollars at the state level. And those of us who pay taxes will be among the ones funding it at the federal level, too. It's a shared responsibility.

Health care is not free, but providing it to less fortunate Americans is the right thing to do.