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Medicaid Expansion: Good or Bad for America?

It’s slated to be an expansion of epic proportions. If the health care reform law pushes forward as planned, 16 million more Americans will receive health care coverage through the federal Medicaid program between 2014 and 2019.

As the Supreme Court considered the constitutionality of that expansion on Wednesday, we broke down the basics with Marcia Coyle of the National Law Journal and posted the audio and transcript of the proceedings so you could peruse the arguments for yourself.

For two more perspectives on the expansion, we turn to Tom Miller, a resident fellow at the conservative American Enterprise Institute, and Ron Pollack, the founding executive director of the left-leaning Families USA. Our basic question: Is the Medicaid expansion good or bad for America?

Tom Miller, American Enterprise Institute

Miller: “This is a very overreaching, unusual exercise of federal power. In this case, the states are saying, ‘You are coercing us to remain in this program under totally radical, revised terms. We are already underwater in terms of our own state budgets with the current program.’ The law says that the states had to freeze their programs in place when the law was passed — they can’t change eligibility, they really can’t change benefits. And then in 2014, they are required to expand their programs even further. If they don’t participate, they’d still be paying taxes into the federal government. They just wouldn’t be getting their proportional share of it.

“If I may use the term, Medicaid is a ‘Hamburger Helper’ to extend the very thin meat. Because Medicaid doesn’t pay doctors and hospitals very well, it seems like it’s cheaper, but what that means also is that the coverage provided isn’t as good as private insurance. And those people are the most likely people to still turn up in the emergency room because they can’t find a doctor to treat them.

“There are other proposals for providing assistance to people to get access to and be able to afford insurance that they need. We need to move more of the low-income Medicaid population into other forms of private insurance. First, we need a better economy. If people don’t have jobs, and don’t have income, they’re going to have problems getting health care under any circumstances. And the second part is to improve what private insurance is available in the delivery of health care so it’s more affordable and a better value.”

Ron Pollack, Families USA

Pollack: “If the argument prevails, there’s going to be no such thing as federal-state programs where the federal government has any accountability. This doesn’t just affect Medicaid, it doesn’t just affect health care — it affects education, environment, civil rights, and transportation, as well as health care. In the 47-year history of the Medicaid program, there have been expansions for children, pregnant moms, people with disabilities and expansions for seniors. There’s never been a case in the 47-year history of the program that found any of the expansions unconstitutional, and I don’t see why this one would be different. This is purely a political protest by Republican governors.

“This [expansion] is going to help the states in a number of ways. First of all, from 2014 to 2016, it is going to result in their getting 100 percent of the cost of these new folks paid for by the federal government. That’s a great deal. The regular payment levels for Medicaid range from 50 to 80 percent, and this will never go below 90 percent. And at the end of the day, this is not an expense item for the states. The Congressional Budget Office tells us (these) Medicaid provisions add less than 1 percent of the Medicaid costs that (the states) would be spending in the absence of the Affordable Care Act. And if you take the Affordable Care Act in its entirety, the states are actually going to save in the aggregate $100 billion in the next six years because they’re no longer going to have to pay for people who are uninsured.”

Photo of Tom Miller by Victoria Fleischer. Photo of Ron Pollack by Brendan Smialowski of Getty Images. Court sketch by William J. Hennessy Jr.

The NewsHour’s Health Page is full of related content about the health care reform law and Supreme Court case, including a timeline, a report card, a cheat sheet, and a public polling update. Watch our broadcast coverage and analysis of the proceedings and browse our photo essays of the ordinary Americans who traveled to Capitol Hill this week to support and protest the law.

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