The Medicaid mystery will greatly affect W.Va.
MEDICAID, the taxpayer-funded health program for the poor, is among the least sexy but most financially significant issues of the 2012 gubernatorial campaign in West Virginia.
The Affordable Health Care law expands Medicaid to up to 138 percent of the poverty level to provide insurance to millions of Americans who have no coverage. In West Virginia, the provision means that the Medicaid rolls will grow from 420,000 to 570,000 people beginning in 2014.
Initially, the federal government will pay the entire tab for the additional enrollees, but by 2020 the state will have to absorb 10 percent of the cost.
The U.S. Supreme Court decision upholding the health care law allows states to opt out of Medicaid expansion. Democratic Governor Earl Ray Tomblin and Republican challenger Bill Maloney are both trying to play it safe before the election.
Last July, Tomblin sent a letter to U.S. Secretary of Health and Human Services Kathleen Sebelius that included 16 questions about Medicaid expansion. Tomblin said during last week's debate that he's still waiting for the answers so he can make "an educated decision."
No doubt Tomblin hopes Washington waits until after Nov. 6 so he won't be pressed on the issue in the three weeks before the election.
Maloney has sent mixed signals on the issue. When asked during the debate whether Medicaid should be expanded under Obamacare, he said, "No, I don't think that's a good idea right now."
But the next day on MetroNews Talkline, Maloney seemed to walk that back, saying, "That's a difficult thing. . . We need more facts."
Well, here are some worth considering:
West Virginia hospitals want the Medicaid expansion, because that means they'll be reimbursed for millions of dollars of health services that are currently written off as charity care.
West Virginians for Affordable Health Care, a broad-based advocacy group, backs expansion because, among other things, it will provide health insurance for low-wage workers. U.S. Senator Jay Rockefeller joins that organization in support of expanded coverage.
Medicaid costs are already growing rapidly, even before the expansion. Medicaid will cost West Virginia taxpayers $780 million this year, twice what we contributed 12 years ago.
Adding 10 percent of the cost of enrolling another 150,000 people will drive costs even higher.
Washington faces enormous budget problems. Going forward, will the federal government force states to pick up a larger share of the additional costs of expanding Medicaid?
If neither Tomblin nor Maloney have yet said whether they support or oppose Medicaid expansion, they are not going to say before Nov. 6.
But, for whoever wins, the decision day will come.
The implications of that choice will affect West Virginia for generations.
Kercheval is host of TalkLine, broadcast by the MetroNews Statewide Radio Network from 10 a.m. to noon Monday through Friday. The show can be heard locally on WCHS 580 AM.