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Jump-starting The Economy--and Health Reform

Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access WeBlog and, happily, he'll now be contributing to The Treatment, as well. Take his opinions seriously; few people boast similar knowledge of health care both in the abstract and in the real world. -- Jonathan Cohn

The U.S. House Ways and Means Committee has put out legislative language for their version of an economic stimulus. As expected, the health components include increased Medicaid matching funds for states, subsidies to help the unemployed pick up COBRA coverage, and investment in health information technology. All of these are appropriate given the economic crisis: They will provide help and coverage to people losing insurance because of the recession and they will quickly increase government spending to stimulate the economy. But what makes the provisions particularly promising is that they represent a "first round" of health reform. 

For example, a big problem in getting medical providers to move towards electronic record-keeping--which cuts down on medical errors and improves efficiency--is that they don't want to shoulder the cost. Now government will be bearing a lot of that cost. The increased Medicaid match for states will help prevent many of them from making proposed cuts in public programs--which, needless to say, is counter-productive at a time when we're trying to expand coverage.  

The most exciting proposal that acts as a "down payment" on health reform is the provision that will allow states to expand Medicaid, temporarily, for unemployed adults. Many people think our public coverage programs cover the poor, but the truth is that they only cover some of the poor. Medicaid largely covers low-income children and parents, and the "aged, blind, and disabled." But there are many adults who don't have a child at home, who are not eligible for any public program-even if they are under the poverty level, which is $10,400/year for an individual, $14,000 for a couple. Sometimes called "medically indigent adults," they are left to whatever their county decides to provide in terms of a safety-net service. 

The stimulus would authorize such a Medicaid expansion only temporarily. But many of the reform plans now circulating in Washington, spanning the ideological spectrum, envision childless low-income adults getting coverage through Medicaid anyway. So by enrolling them in Medicaid now, the stimulus would basically jump-start the reform process--making the long-term job of getting everybody covered that much easier. 

--Anthony Wright