California's Democratic-controlled Legislature has been an enthusiastic supporter of the 2010 federal healthcare reform law, but it has yet to take advantage of one of the most important provisions: the opportunity to offer Medi-Cal, the state's version of the Medicaid insurance program for the poor, to more Californians largely at the federal government's expense.
Gov. Jerry Brown hasn't committed mainly out of concern about the potential cost to the state. There's little doubt that the expansion would increase Medi-Cal costs over the long term, but the amount would be small in comparison to the state's total Medi-Cal budget — and to the billions of dollars in new federal aid flowing to doctors and hospitals. The benefits to the public — including higher productivity, better health and fewer unpaid bills at county hospitals — more than justify the investment.
As part of a multilayered effort to make healthcare more efficient and effective, the 2010 law sought to extend insurance to millions of Americans without coverage. To reach the poorest uninsured, it called on states to extend Medicaid at least to those earning up to 138% of the federal poverty line — including able-bodied adults without children, who'd previously been ineligible no matter how low their incomes — starting in 2014. The feds' share of the cost of the expansion would start at 100% for three years, then drop gradually to 90% by 2020. But as the federal Department of Health and Human Services announced Monday, that extra aid for any of the newly eligible would flow only if states expanded their Medicaid programs to the full extent called for by the 2010 law.