Praising Arizona: MO Medicaid 'Reformers' Make Jan Brewer Look Like the People's Champ

Late in May, I wrote about how Jan Brewer, the GOP governor of Arizona, went to bat for the Affordable Care Act's Medicaid expansion in her state. She fought tooth-and-nail against her once simpatico tea party legislature. Thursday, I learned that she managed to prevail in her fight.

This is a good example of what all-out commitment will do and might suggest just why Missouri's cautious, low-key Democratic governor isn't able to achieve similar goals.

Of course, it looks like Missouri's GOP-dominated legislature may be reconsidering their refusal to expand access to Medicaid. Or, perhaps they're just worried that blowback from such a wanton rejection of improvements to Missouri's quality of life might hurt them in the long run. It seems that both houses have now appointed panels that will prepare Medicaid "reform" legislation for the 2014 session.

Sadly, I fear the so-called reforms these ALEC-fearing jokers might have in mind will be almost as bad as going without Medicaid entirely. Last year, some GOP lawmakers supported changes that would have moved Medicaid into private, managed care systems which have proven problematic for many states (see here, here and here).  It's likely that they will continue down the path toward what State Rep. Jay Barnes (R-114) speculated could be "the most market-based system in the entire country."

Of course, many healthcare economists are unequivocal about the biggest problem contributing to rising health care costs: our nearly unregulated private delivery system which brings perverse incentives and cumbersome administrative costs. But if it gets more people into the system, I say we can afford a little degradation in the service. That's just the usual cost of doing business with ideologues and corporatists.

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