Many governors, including other Republicans in Nevada, Arizona, Ohio and Florida, have run the numbers and decided that Medicaid expansion is an offer they just can't refuse. Though, like many other Republicans, those governors didn't have much good to say about the larger Affordable Care Act, they have found that the alternative to Medicaid expansion would be to leave many hundreds of thousands of their state's residents, many of them hard-working families who now earn just a little too much to be eligible for the current Medicaid program, to face an inhuman choice between illness or bankruptcy, or both.
The numbers are there. The federal government will pay 100 percent of the cost of broadening Medicaid coverage to all persons with incomes under 138 percent of the federal poverty line for the first three years, and 90 percent of the costs thereafter. And that expansion would move into Medicaid those people whose medical expenses now fall solely onto the state, such as prison inmates, or onto local governments, such as people with mental illness.
Not only would the bill preventing state participation in Medicaid expansion HB391 end the debate prematurely, it would also make it impossible for Herbert to bargain with federal officials for alternatives other than just in or out. The governor has proven himself ready, willing and able to dicker with the feds over this and other issues, and other states have floated variations and hybrids that may be easier for the free-marketeers of the Wasatch to swallow.
A knee-jerk rejection of Medicaid expansion, as called for by HB391, would be foolish, both fiscally and ethically. If the bill passes in its current form, Herbert should not hesitate to veto it.