If we want to expand Medicaid, we've got to enhance it
I've heard several progressives suggest that Democrats abandon comprehensive health care reform and just expand Medicaid to cover everyone who can't afford insurance. Expanding Medicaid could provide coverage for 35-45 million Americans and ultimately save billions of dollars.
Now that the Democrats' filibuster-proof majority is toast, reformers are brainstorming alternative routes to reform. According to one school of thought, the House should just pass the Senate bill, or a modified version thereof. Another camp maintains that the bill should be broken down into smaller, less controversial chunks which the Republicans wouldn't dare filibuster. Be skeptical of any political strategy predicated on the assumption that something is so universally beloved or obviously beneficial that the GOP wouldn't dare obstruct it.
Maybe it would be easier to pass the Medicaid expansion alone than it would be to get the House to pass any version of the Senate bill. Both the House and the Senate have already passed bills that would expand Medicaid. A Medicaid expansion might placate the two main pockets of opposition to the Senate bill in the House: the anti-abortion contingent and the public option purists.
Medicaid-only might shut up Bart Stupak and his anti-choice cronies, assuming they aren't just using abortion as a poison pill to kill health reform. The Hyde Amendment already applies to the federal side of Medicaid, so the anti-choicers can't truthfully say they're being forced to vote for an expansion of abortion coverage. Though, again, be skeptical of a political strategy that assumes anti-choicers won't lie about easily checkable points of fact or law. After all, they claimed that the Capps compromise was federal funding for abortions.
Finally, Medicaid-only would be a win for all the House progressives swore they'd never vote for a bill without a public option. Medicaid is the ultimate public option.
So, let's assume it's easier to pass Medicaid-only than the full Senate bill. Would expanding Medicaid ultimately provide better insurance for more people?
Ellen-Marie Whelan, a nurse practitioner and an analyst at the CAP Action Fund says it's not that simple. Practitioners who accept Medicaid are already in short supply. Adding tens of millions of people to the Medicaid rolls without beefing up the program will push health care further out of reach for millions of Americans.
In her latest Wonk Room post, Whelan outlines a plan to strengthen Medicaid and the public health system in order to accommodate millions more beneficiaries.
So, "Medicaid-only" really means "Medicaid expansion, plus higher reimbursement rates, plus training more primary care providers and public health workers." That's still a dramatically streamlined proposal compared to the Senate bill. Nothing in Whelan's proposal would alienate the anti-choicers or the public option proponents.
The question remains whether it would really be easier to pass Medicaid expansion vs. a modified Senate bill. The Blue Dogs wouldn't like it and the unions would be upset that the excise tax stayed in the picture.