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My view: Expanding Medicaid would benefit Utahns in many ways

By Matt Slonaker

Published: Sunday, Jan. 13 2013 12:00 a.m. MST

Some are concerned about expanding Medicaid because of budgets.

Associated Press

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If Utah moves forward with the expansion of Medicaid — as Nevada, Colorado, New Mexico, and Montana are doing — we would be giving our most vulnerable citizens more control over their health care, their families and their futures.

Many of us take being healthy or having insurance for granted. But too many Utahns aren't as lucky. More than 400,000 of our friends and neighbors lack access to health care insurance. For uninsured families, getting sick isn't only an inconvenience. Just one illness could result in impossible debt, missing work or losing a job. If we don't expand Medicaid, 17 percent of Utah's most at-risk adults — those under 138 percent of the federal poverty level (which is $26,000 for a family of three) — will be left out of coverage because of a cruel gap in the system.

Despite their long hours, health care insurance for the likes of college students or hairdressers is often financially out of reach. For instance, there's Joe P., a native Utahn proud of his pioneer heritage. Joe wants to expand his small business and create jobs, but he can't qualify for Medicaid or afford private insurance. When a diagnosis of kidney cancer and a medical error left him with half a pancreas, he had nowhere to turn for medical care. As a double high-risk patient, he must pay for special insurance that costs more than $1,000 a month. For this Utah entrepreneur, the path to create more jobs is much harder.

Too often, the concepts of health care rights and responsibilities are viewed as separate. We think they go together. Health care is a right with responsibility. Under our current system, health care is a right only in the worst possible setting: the hospital emergency room. But most health problems can be resolved before they get out of hand. Without insurance, families often wait until conditions get worse and have no choice but to rush to the hospital. Policymakers should view health care coverage, whether through Medicaid or the private market, not as an entitlement, but as a tool for families and individuals to responsibly manage their health.

Expanding Medicaid will also benefit our community. Uninsured families who use emergency rooms often can't pay their bills. This forces hospitals to pass these expenses onto those who have insurance. In the end, insurance premiums absorb the cost of treating the insured, adding almost $1,000 per year to everyone's health care costs.

So, how can we fix this problem? The most efficient option is to move forward with the Medicaid expansion. Why expand Medicaid and not something else? Because Medicaid, due to its efficiencies and economies of scale, boasts very low administrative costs — much lower than private insurance. It also registers slower per-enrollee cost growth than Medicare and private insurance.

When the Congressional Budget Office ran the numbers, it discovered that expanding Medicaid saved taxpayers the most money — more than private insurance or premium subsidies. The expansion will also be funded at a very generous match rate from the federal government — 100 percent for the first three years and phasing down to 90 percent in following years. Compare that to current Utah Medicaid match rate, which is 70 percent of federal dollars and 30 percent from the state.

During the next 10 years, the expansion would inject $5 billion of federal funding into Utah's heath care industry. That money — our taxpayer dollars — will go to other states if we reject the expansion. So let's join our Western neighbors and approve the Medicaid expansion. All Utahns deserve to take control of their health care.

Matt Slonaker is the Medicaid Policy and Collaborations director at Utah Health Policy Project.

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