Prometheus 6

The House bill would begin expanded coverage in 2013 and expand Medicaid to cover Americans up to 150 percent of the federal poverty level, currently about $29,300 for a family of four and $14,400 for an individual. The Senate bill would begin in 2014 and extend Medicaid to Americans up to 133 percent of the federal poverty level.

Under the Senate bill, the federal government would pay the entire cost of expanding Medicaid to those not already covered by the states for the first two years of the program. The following three years, states that have not expanded coverage would be reimbursed at a higher rate than those states that have already done so — in general, the states without expanded coverage would be paid back 95 percent of their costs, while those that have already expanded coverage would be reimbursed between 80 and 95 percent.

The biggest hit to states that have expanded coverage will be in covering the people who are eligible but have not signed up for coverage under the state’s current program....States that have expanded already would not get any new matching funds for those people. The bill provides additional money only for those who are “newly eligible.”...The House bill largely eliminates the problem of signing up people who are now eligible under state programs by counting anyone who signs up as “newly eligible.” The biggest expansion of Medicaid will be among childless adults under 65.

States With Expanded Health Coverage Fight Bill
By KATE ZERNIKE

States that have already broadly expanded health care coverage are pushing back against the Senate overhaul bill, arguing that it unfairly penalizes them in favor of states that have done little or nothing to extend benefits to the uninsured.

With tax revenues down and budgets breaking, the states — including Arizona, California, New Jersey, New York and Wisconsin — say they cannot afford to essentially subsidize other states’ expansion of health care.

The bill passed by the Senate on Thursday would move toward universal health insurance coverage in large part by expanding Medicaid, a program whose costs have traditionally been shared by the states and the federal government.

But the roughly 20 states that have already expanded coverage in some form will pay a greater proportion of their new Medicaid costs under the bill than those states, largely in the South, that until now have covered relatively few of their poorest residents.

Medicaid, the federal health program for the poor, covers about 60 million Americans and accounts for about one-fifth of state budgets, on average. Even governors in some states without expanded coverage are suggesting that their budgets cannot afford a widened program without additional federal assistance.

“There is always an issue with Medicaid that different states are in different places,” said Diane Rowland, the executive director of the Commission on Medicaid and the Uninsured at the Kaiser Family Foundation. “Do you reward the leader states as well as the laggard states, the good states versus the bad? How do you equalize the assistance? That’s at the heart of this.”...