Utah commits to Medicaid expansion. Are we at a tipping point?

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This, according to the Salt Lake Tribune, is undoubtedly good news for thousands of uninsured Utahans. On Wednesday Utah Gov. Gary Herbert told reporters he wants to move forward on the Medicaid portion of the Affordable Care Act during his monthly news conference, stating that “[d]oing nothing … I’ve taken off the table. Doing nothing is not an option.” The public commitment from the governor, praised by state Democrats, sets the stage for expanding the joint state-federal insurance program for low-income Americans. No other details were given, but as the National Journal reported the “governor is considering two expansion plans offered by the state legislature, both of which involve using the Medicaid dollars toward private plans.”

A “private option” proposal was accepted by Health and Human Services (HHS) in Arkansas. Iowa, Pennsylvania, and Michigan are also pursuing similar avenues towards insuring those with annual incomes below 138 percent of the federal poverty line (just under $27,000 for a family of three). Using Medicaid dollars to enroll those in the coverage gap — residents who earn too much under existing state eligibility standards and too little to qualify for subsidies on the insurance exchanges — is certainly a possibility in other states who have so far declined to expand the program. For instance, the recent confluence of red states moving forward might influence those discussions that were planned between HHS and Indiana Gov. Mike Pence.

Utah’s decision now means, as Dan Diamond wrote in Forbes, that a majority of states have or are planning to expand Medicaid in one form or another. It’s also worth considering, at this point, that this portion of the health care law may slowly (and quietly) be disengaged from broader Republican opposition.

The Washington Post’s Greg Sargent adroitly noted as much, that the expansion “is kind of taking on a life of its own, independent of Big Bad Obamacare.” Moreover, Jonathan Bernstein, building off of Sargent’s post, took a preliminary look at GOP gubernatorial candidates in expanding states run by Democrat governors. Bernstein wondered how many were pledging to repeal the Medicaid expansion if elected, and the answer was none.

That’s a good sign for residents in those states who’ve already committed to the expansion, and this week’s news is certainly a victory for the nearly 60,000 uninsured Utahans who would otherwise fall into the coverage gap. Yet that number is a drop in the bucket compared to the number of Americans left behind in states like Texas and Florida. Those two alone account for 1.8 million people who will remain uninsured.

These folks aren’t a categorical political constituency, and opposition (or support) to health care reform largely depends on whether you like the president. It may be too much to ask for the type of moral imagination that Ohio Republican Gov. John Kasich displayed, but one could hope that reducing economic precariousness for millions of Americans will get easier as the politics of expanding Medicaid recedes. I certainly do.

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