How Will The Next Washington Governor Shape Medicaid?

Whoever is elected as governor this fall could change the course of Washington state's Medicaid program. When the US Supreme Court ruled on the Affordable Care Act in June, it determined that the law went too far when it required states to expand Medicaid. The ruling left it up to states to decide whether or not to open up the program to cover people without insurance.

In Washington, Governor Chris Gregoire chose to continue with plans for expansion, but the new governor will determine how those plans are carried out, and how much the state spends on the program. Medicaid is restricted to low-income children and their parents, people with disabilities, and the elderly. Currently more than 1.2 million Washington residents get health coverage through Medicaid. Enrollment to the program has gone up since 2008. That’s about to change in 2014. Medicaid will open up to include adults without children and eligibility will be based on income. For a single person that threshold is just under $15,000 in annual income. For a family of four, it’s $30,657.

Republican candidate Rob McKenna says he’s for expansion, but with restrictions. He doesn’t support the Romney-Ryan plan for Medicaid that would give states block grants. As Washington Attorney General, McKenna joined the lawsuit that challenged the Affordable Care Act. He specifically opposed the law’s individual mandate. He says the recent Supreme Court ruling gives states some leverage to negotiate with the federal government on how to run the program. For example, he’d like to require Medicaid clients to share costs.

“We’re only one of the states where there’s not even a $5 co-pay. What we’re saying is that everyone has to have some financial skin in the game, even just a little bit,” says McKenna.

In early projections, the state estimates that half a million residents would qualify under the expanded program, and roughly half of them would enroll. McKenna wants Medicaid to be maintained as a safety net. But he fears that many employers will stop providing health insurance for their employees and those people will end up on Medicaid. “Our goal needs to be keeping as many people on private coverage as much as possible, and not moving as many people as possible on to Medicaid,” he says. Democrat Jay Inslee voted to approve the Affordable Care Act when he was in Congress, and he supports Medicaid expansion. He says doing so helps people without insurance. Inslee says there are fiscal benefits for the state, too, because everyone bears the cost for those who don’t have health coverage.

“We know that when people do not have insurance, they get their health care in one place, and that’s the emergency room," he says. "Instead of getting routine treatment for the flu, their asthma, or whatever, from a primary care doctor, they go into the emergency room. And that costs four to five times more money to have the same treatment in the emergency room. And you know who it costs — it costs you and me.” Inslee says those charges are billed to insurance carriers, and the carriers pass on those costs to consumers. He says expanding Medicaid is one way to make sure that federal taxes paid by Washington residents are used to help Washington. “Look, we’re going to pay these taxes one way or another. This money is going to Washington, DC, one way or another. The question is, where does it go then? Does it go just to Florida and California, or does it come back to the state of Washington by hundreds of millions of dollars?”

If Washington continues with Medicaid expansion, the federal government will pick up 100 percent of the tab for the first three years. Over time, the federal match tapers to 90 percent by 2020. The race for governor remains tight. New poll numbers by Elway Research shows McKenna with a slight lead by two points.