Medicaid key to perception of healthcare reform

While it is the federal government dealing with the hot potato of healthcare reform right now, eventually it might boil down to state officials to determine how palatable changes are to North Dakota residents.

The issue is Medicaid expansion, which North Dakota opted into. Opting out of the expansion might be considerably more complicated.

As part of the Affordable Care Act, North Dakota was one of the states that agreed to expand Medicaid coverage for lower income earners who did not previously qualify for the benefit. Under the plan, the federal government picked up the bulk of the tab for some time. Although there was some conservative backlash to the decision by the state, the expansion still extended coverage to tens of thousands of North Dakotans.

While many aspects of the current legislation in the works are fluid, it appears that federal investment in the Medicaid expansion is going to get hacked, perhaps considerably. The state would then be left to pick up more of the tab, end the expansion or engage some new machination.

It is this decision which may determine how healthcare changes are received here. If thousands of low-income North Dakotans are suddenly without access to care, there would be considerable political ramifications. This would play right into the hands of reform opponents already claiming that proposed federal cost savings would be paid for in human lives. Imagine how inflammatory the rhetoric would become.

It isn’t just politics and perception. The Medicaid expansion has particularly benefited some rural residents and even critics of the cost would have to acknowledge it is a lifeline for many at-risk beneficiaries.

The great complication of healthcare reform is that it sits at the nexus of financial and ethical considerations. How North Dakota addresses whatever change is coming to Medicaid might go a long way in determining how the people of the state view the post-Obamacare landscape.

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