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The latest from a really helpful ProPublica project that breaks down how health-care reform would affect specific groups illustrates how the bill seeks to standardize state participation in Medicaid programs. The piece profiles a young single woman unable to work because of Chronic Fatigue Syndrome, who was forced to move from Maine -- where she was only eligible for temporary Medicaid -- to Pennsylvania, one of only 15 states in which low-income adults are eligible for Medicaid benefits. At present:
Some states cover childless adults, some don’t. Physical therapy may be covered with a $1 co-payment – or not at all. This variability among states is one of the major complaints about Medicaid, and is one that the Senate and House health care bills attempt to remedy.Caveat? But of course:
States that already offer coverage to adults beyond federal requirements would get less federal help in the years before 2019. Not surprisingly, these states aren’t happy about this, arguing that they are being penalized for their efforts ... to cover more uninsured residents.The disparities in some cases defy understanding. And on balance, it's a good thing that people won’t have to move to different states if they want to get the coverage. However, a pretty serious tweaking of incentive structures seems in order: State governments that picked up the slack in the absence of federal health reform and sought to reduce their numbers of uninsured should be supported in their efforts instead of handicapped while the federal governments and other states catch up. --Laura Dean
