Posted by AzBlueMeanie:
The Arizona media has given Governor Jan Brewer props for her decision to support Arizona's participation in the expanded Medicaid provisions of the Affordable Care Act ("ObamaCare"). Governor Brewer was cast as a beneficent leader bestowing mercy on the unfortunate in need of medical care.
Now we learn that Brewer's beneficence may have really been motivated by immigrants (but of course). Sarah Kliff at Ezra Klein's Wonkblog writes, Arizona could make the Medicaid expansion an immigration fight:
Arizona Gov. Jan Brewer’s decision to participate in the Medicaid
expansion was a puzzling one: Why would one of the nation’s most
conservative governors opt into an Obamacare program that most of her
Republican colleagues have rejected?
New budget memos
from the state provide some insight: Opting out of the Medicaid
expansion had the potential to give immigrants better access to health
care than American citizens.
This small quirk in the Affordable Care Act that Arizona stumbled on
could significantly reshape the politics for governors weighing whether
to sign up for the health law’s Medicaid expansion.
The dilemma raised by Brewer’s budget advisers is this: Turning down
the Medicaid expansion would mean giving low income, legal immigrants
access to private insurance subsidies unavailable to American citizens.
“If Arizona does not expand, for poor Arizonans below (the federal
poverty line), only legal immigrants, but not citizens, would be
eligible for subsidies,” budget documents turned up by the AP note.
Here’s how that would work: Under the Affordable Care Act, the only
American citizens eligible for government subsidies to purchase private
coverage are those who live above the poverty line (earning more than
For legal immigrants, however, things work differently. Medicaid has,
for decades, now imposed a five-year waiting period before they can
gain coverage. The Affordable Care Act, however, created a new option:
Any legal immigrant, no matter how long they had been a resident of a
given state, could purchase health coverage on the new exchanges and
qualify for the subsidies.
* * *
All of that seemed like a decent setup when the law passed. Then the
Supreme Court came along and told states they didn’t have to expand
Medicaid. If a state does not participate in the expansion, then all of
its American citizens below the poverty line will not qualify for
Medicaid or private insurance subsidies.
Legal immigrants would, however, qualify for the latter. And that
explains where Brewer’s budget advisers saw the decision to opt out of
the Medicaid expansion as one that would leave only “legal immigrants
but not citizens” eligible for a new, federal program.
This was, of course, not the only factor that mattered in Arizona’s
decision. The state noted that it could expect an additional $1.6
billion in federal funds, to finance the expansion, should it move
* * *
Now that Arizona has brought this issue into the Medicaid expansion
debate, it should be interesting to see how other states navigate around
it. Will Gov. Rick Perry in Texas stand for legal immigrants having
better access to health insurance subsidies? What about Gov. Rick Scott
in Florida? It’s a new wrinkle in an old debate, that might make it a
bit harder for Republican governors to turn down these Obamacare funds.
Ulterior motives or not, the expanded Medicaid provisions are a good deal for Arizona and an economic boost.