Alan Weil, executive director of the National Academy of State Health Policy, used an analogy that any bargain-conscious New York shopper could grasp to describe how states may view Medicaid expansion under health reform.
Medicaid is jointly financed by states and federal spending, and this year's reform law will expand the safety-net insurer's eligibility, beginning in 2014.
Speaking in Washington about the release of estimates that states will bear a fraction of the cost of expanded Medicaid enrollment (conservatively $21.1 billion of an overall $464.7 billion to cover 15.9 million people through 2019), Weil used deeply discounted shoes to explain, in part, why states haven't roundly applauded reform.
“I'm often asked if the Medicaid expansion is a good deal for states and I give people the image of walking into a shoe store and seeing a $200 pair of shoes on sale for $20,” he said. “Is that a good deal? Well, if you like the $200 pair of shoes, it's a great deal because you only have to pay 20. If you look in your wallet, and you see a 10 and a couple of ones and you've got some change in the bottom of your pocket and you're not sure you can come up with the $20 it doesn't really matter what a good deal it is.”
He continued: “And much of the difference in perspectives in state response to the Medicaid expansion has to do (with) whether they're focusing on what they're going to get, which is a lot more than they have to put in, or whether or not they feel they can afford the small, relatively small, amount that they'll have to put in.”