The evidence is piling up that opting to expand Medicaid under the Affordable Care Act makes a lot of sense. The arguments for New Jersey joining 20 other states that represent well over half the nation's population include:
- It would provide health insurance and decent health care to about 375,000 New Jersey adults -- or about 30 percent of the state's uninsured population.
- The persons covered -- those whose incomes are between 100 and 138 percent of the federal poverty level -- have no alternatives available except to use clinics and hospital emergency rooms. Most of them are not eligible for the subsidized insurance that will be available to those with incomes above 138 percent through the health insurance exchange, nor do their incomes permit them to buy insurance on their own.
- Many of those covered by the expansion are workers. We seem them in restaurants, gas stations or tending to suburban lawns. They are playing by the rules but not living the American Dream.
- Most of the remaining uninsured are unemployed, looking for work and trying to hold on. The stereotype of shiftless "takers" does not apply.
- New Jersey's fragile economy would receive a real boost of about $2 billion each year in federal dollars to not only provide quality health care, but to expand business activity and create new jobs.
- The federal government pays the full bill for the first three years and thereafter the state's share never exceeds 10 percent of the full costs. This is a rare opportunity for New Jersey to get more of its federal tax dollars returned home (we rank last in the proportion of our tax dollars spent by the federal government in the state).
The arguments against choosing to expand Medicaid are hard to find, but seem to boil down to these three:
- Life is uncertain and there is no air-tight guarantee that the federal government will live up to its pledge to foot most of the bill.
- The federal government has yet to answer every question that might be posed by the implementation of the most comprehensive legislation enacted in the last half century or so (Medicare and Medicaid were signed into law in 1965).
- Gov. Christie's opportunity to run for the 2016 Republican nomination might be hindered if he demonstrates the slightest support for Obamacare.
We'll agree that we live in an imperfect world, so the first two objections are noted. On the third, it is worth considering that four Republican governors have recently joined the ranks of the Medicaid expanders, despite the seemingly solid party opposition voiced during the Republican presidential primaries last year. The fact that Gov. Jan Brewer of Arizona is one of them should be a source of political cover to Gov. Christie.
Gov. Brewer is the quintessential hard-right, Tea Party-beloved Republican. Among her credentials:
- She called a special session of the legislature to authorize Arizona joining the class action litigation to find Obamacare unconstitutional (Gov. Christie did not join his 21 Republican colleagues in the suit).
- She signed legislation to allow police to stop and demand proof of legal residence of anyone thought to be an undocumented immigrant.
- She approved policies that allow Arizonans to carry concealed weapons without a license in bars and restaurants (as long as they don't drink) and to "stand their ground" by shooting anyone threatening them (after announcing that they are armed).
- She signed the most restrictive anti-abortion law in the nation, one that defines pregnancy as occurring two weeks before conception.
- She refused to allow now-legal immigrants under President Obama's Deferred Action for Childhood Arrivals order to quality for an Arizona driver's license (a practice now authorized in 30 states).
Needless to say, Gov. Brewer surprised many with her decision to opt in to the Medicaid expansion. Her statement could be easily modified by Gov. Christie:
"My concerns about the Affordable Care Act are well-known, but it is the law of the land. With this expansion,
ArizonaNew Jersey can leverage [nearly] more than $8 billion in federal funds over four years, save or protect thousands of quality jobs and protect our critical rural and safety-net hospitals.
. . . .
Arizona'sNew Jersey's tax dollars would simply be passed to another state - generating jobs and providing health care for citizens in California, Colorado, Nevada, New MexicoNew York, Maryland, Connecticut or any other expansion state.
With this move, we will secure a federal revenue stream to cover the costs of the uninsured who already show up in our doctor's offices and emergency rooms.
Under the current system, these costs are passed along to Arizona families. Health care premiums are raised year after year to account for expenses incurred by our hospitals as they provide care to the uninsured.
This amounts to a HIDDEN TAX estimated at nearly 2 Thousand dollars per family, per year. On top of this, New Jersey's budget sends $700 million in charity care to cover a part of the costs of uninsured patients -- we could save many of these dollars.
If Gov. Brewer can buy into state savings, support for safety-net hospitals, protection and creation of jobs, an infusion of federal funds and health care for struggling citizens, so can Gov. Christie.