Expand Medicaid

Part of the deal that Obamacare had to make with the Devil — aka, the Supreme Court of the United States — for its survival was that one key part intended to expand health care coverage to many of the millions of Americans who now lack it stopped being a requirement and instead was left up to the tender mercies of the various states.

But there is nothing tender about the fact that states that accept the plan to expand coverage to the poor will benefit economically. And there is nothing merciful about any state that would reject the plan as a way of making a harsh ideological statement at the expense of its most vulnerable residents.

Utah is among the states still riding the fence on the question of whether it should expand the existing Medicaid system that has long provided some measure of health insurance to the poor. It should accept the offer.

By raising the income limits for Medicaid eligibility and opening enrollment to single adults without children, that part of the Affordable Care Act was to extend coverage to maybe half of the 30 million Americans who, unconscionably, now go without. But so many states have stepped through the Supreme Court's loophole and rejected the expansion of Medicaid for their low-income residents that, according to a recent analysis by the Associated Press, nigh onto 10 million of the 15 million Americans who should have been rescued from the status of uninsured will not be reached.

As more and more states — with a Republican governor, Republican-controlled legislature, or both — reject expanded Medicaid, it becomes more and more apparent that they are doing so for just the reason outlined recently by New York Times columnist and Nobel laureate economist Paul Krugman says they are: Pure spite.

Expanding Medicaid on the federal dime will help Utah's poor, Utah's hospitals, Utah's counties, Utah's insurers and Utah's patients by helping low-income families get the basic care they need without crowding emergency rooms, leaving bills unpaid or going without care until a health problem becomes acute and more expensive to treat.

All those costs now get passed along to state and local governments, hospitals, insurers and those who pay for their own health care in the form of higher hospital bills. Putting more people on expanded Medicaid will do more than anything else on offer to control costs while still providing health care to those who need it.

Utah leaders, who pride themselves on running an efficient government, would be foolish to reject this opportunity.