Thus far, 25 states (including D.C.), have opted for expansion, while 26 (mostly red) states remain on the sidelines.
Of the 37,000 people who have thus far gained health coverage in New York, for example, two-thirds qualified through Medicaid.
In Washington, the Medicaid expansion accounts for half of its 35,000 new enrollees. In Kentucky, four out of every five of the state’s 26,000 newly insured can thank Medicaid for their benefits.
Two main factors account for Medicaid’s early success. First, states operate their own Medicaid programs, which means they are largely insulated from the federal government’s IT issues.
Second, a handful of states have taken advantage of a “fast-tracking” option permitted by the federal Department of Health and Human Services. Fast-tracking, or facilitated enrollment, allows states to offer an express lane to residents already known in their welfare systems, such as food stamp recipients.
Because eligibility standards for food stamps are generally more stringent than those for Medicaid, states can effectively presume such individuals are eligible for the Medicaid expansion and enroll them with minimal hassle, conserving valuable administrative resources and bypassing bureaucratic delays.
Persuading the Cynics
All this is well and good, but it is unlikely to make converts of Obamacare’s critics.
What may change their minds, though, are costs. The major argument expansion opponents make is that it will be too expensive for cash-strapped states.
Here, the evidence is encouraging.
The federal government will bear the lion’s share of new Medicaid costs through 2016, declining to 90 percent by 2020.
If all states expand Medicaid, the feds will inject $952 billion into state budgets between 2013 and 2022. In other words, the feds are paying for 93 cents of every new Medicaid dollar.
As if this wasn’t already a good deal for states, it gets even sweeter—because states will save billions on lots of things they currently pay for.
When the uninsured seek medical care but do not pay for it, the bill falls to someone else—and that someone else is usually the government.
Open Systems expert Merrelyn Emery
The final section of the paper looks at the necessary and sufficient conditions
for the current wave to succeed; that is for it to enable a return to active adaptive
organizations and communities in which people may fulfil their destinies as the
purposeful systems they are and, thereby, tame the social field into one that supports and
fosters a new global culture of cooperation, wisdom and joy.