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Legislature could fight over health care for more people

House Minority Leader Richard DeBolt Credit: Washington State Legislature

Expanding Washington's Medicaid system means health care for more people plus free federal money in the immediate future. But would such an expansion cost the state more money years down the road?

That question could lead to conflict as the state's legislative session for  2013-2015 begins.

Washington provides $9.9 billion in low-income medical care for 2011-2013 — slightly more than $4.5 billion from the state and slightly more than $5.3 billion from the feds. The Medicaid portion is intertwined with those figures, with too many factors involved to draw out specific Medicaid dollar figures. About $400 million of the the state's share comes from a hospital beds tax that is due to expire later this year, and which the Legislature must decide whether to renew. The rest comes from the state's operating budget.

Expansion of Medicaid could provide health care coverage for up to 340,000 and, by estimates of the liberal Washington State Budget & Policy Center, the state itself could net some $200 million in savings in the first two years because of other costs that will be picked up by the federal government.

To Sen. Karen Keiser, D-Seattle, expanding Medicaid is a no-brainer; the feds will supply the cash and more people will be covered by Medicaid. Keiser is the ranking Democrat on the  Senate Health Committee.

But Republicans are leery about what will happen in yet-to-be scheduled outlying years when the federal share of Medicaid begins to decrease,  which will cause Washington's share of the Medicaid budget to increase, said Republican-allied Sen. Majority Leader Rodney Tom, D-Bellevue, and House Minority Leader Richard DeBolt, R-Chehalis. "We want to make sure we're not going to take on long-term liabilities," DeBolt said last week.

At this time, calculations have not been made on what Washington will pay whenever the federal share of Medicaid shrinks. Some of those calculations will depend on upcoming guidance from the federal government.

Medicaid provides medical services for low-income people and families with the definition of "low-income" depending on the number of people in a family and many other circumstance. Right now, about 1.2 million Washingtonians —18 percent of the state's population  — are eligible for Medicaid. That includes half of the state's children, half of the state's pregnant women, 10 percent of its senior citizens and 7 percent of Washington's other adults,

Depending on if and how much the Legislature decides to expand Medicaid, 62,000 to 343,000 more people could be enrolled. If the Legislature decides to expand Medicaid, that addition will go into effect on Jan.1, 2014.

Potential new groups of people to be covered could include childless adults, such as recent college graduates who are in low-paying service jobs that don't provide health benefits, Keiser said.

Hovering in the background is a legal question that could have bearing on future state finances: whether states can cut Medicaid, an action that would likely lead to parallel federal cuts to its Medicaid appropriations to that state. A case is before the 9th U.S. Circuit Court of Appeals on whether patients and health care providers, such as doctors, can sue to block Medicaid cuts.

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