DC Makes Right Choices on Health Care Reform

Reading about how states are responding to the Affordable Care Act, I feel proud to live in the District of Columbia.

Only 10 states have decided to expand their Medicaid programs by the 2014 deadline. The District has charged ahead.

It’s already lifted its income eligibility ceiling to 133% of the federal poverty line, as the ACA required — until the Supreme Court in effect said it couldn’t. The District has also requested — and received — a waiver to lift the ceiling to 200% of the FPL.

This is so fiscally smart.

Under a separate program called the DC Healthcare Alliance, the District had been paying the full costs of health coverage for people with incomes below 200% of the FPL who couldn’t qualify for Medicaid.

Now it’s shifted a majority of them from the Alliance into Medicaid. The federal government pays its regular 70% share of the costs. And as of 2014, it will pay 100% of the costs for the newly-eligible at or below 133% of the FPL.

Another cause for pride is the DC Council’s decision to preserve enough funding for the Alliance so that it can still cover hospital-based services for adults who can’t be shifted — mostly undocumented immigrants, we’re told.

Consider that some states are doing their best to drive these people out — most of them among the states that won’t admit even more poor U.S. citizens into their Medicaid programs.

And since I’m beating the drum here, I’ll add that the District has moved ahead to establish an exchange for health care insurance purchases, as the ACA envisions.

Only 14 states have even established the necessary legal framework. Mayor Gray signed the District’s law in January — after what seems to have been a good bit of work by an interagency task force, including efforts to get public input.

Virtually all states have gotten grants to plan exchanges, as has the District. But 17 of them decided to stop or slow down planning until the Supreme Court ruled on the ACA. Another six hadn’t really gotten started.

Now these states are behind the eight ball. If they don’t have a “blueprint” ready by November, the federal government may decide to run an exchange for them — just the kind of “takeover” conservative ACA opponents deplore.

Rhetoric aside, the laggard states may, for various reasons, wind up with a health care system that’s less satisfactory than what they’d otherwise have.

Six states have nevertheless decided not to even try to establish exchanges. Seems we’ve got a new legal strategy for making the health reform plan crash. Or maybe two.

Some ACA opponents, including a bunch of Congressional Republicans, now claim that the ACA doesn’t allow the federal government to impose penalties on employers who won’t provide adequate, affordable health insurance except in states that operate their own exchanges.

Others argue that the federal government can’t provide subsidies to households who purchase health insurance on exchanges that state inaction constrains it to create.

So we can look forward to more brawling in Congress — and perhaps another round of lawsuits.

But, as things stand now, these attacks on the ACA won’t affect District residents because our policymakers have viewed the law as an opportunity to “ensureĀ  … access to quality, affordable health care” for all of us.

You’d think this would be a no-brainer. It’s a testimony to our times that it’s worth a shout-out.

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