Medicaid Expansion

The Affordable Care Act (ACA) makes federal funding available to provide adults earning up to 138% of the federal poverty level (about $16,100 for an individual) with health coverage through Medicaid. Under the ACA, the federal government will fund 100 percent of the costs for states to cover newly eligible adults from 2014 to 2016, gradually moving to 90 percent of the costs by 2020.

Because of a 2012 Supreme Court ruling, each state has the right to accept or refuse this expansion of coverage. A little more than half of the states—mostly Democratic-leaning jurisdictions—have accepted the money and are providing expanded coverage. There is no deadline and any state can switch positions.

Average voters know almost nothing about this. You will have to explain it to them, but the need to explain is also an opportunity to convey your values.

Say . . .

Our economy is a wreck and families are really hurting. We have to energize our state’s economy and also provide some security to hard-working people. Now we have a chance to do both. Under the Affordable Care Act, the federal government is offering millions of dollars to states to expand health insurance for working Americans who can’t afford it. This money would cover the entire cost of expanding health coverage through 2016—our state pays nothing. After 2016, the federal share gradually declines to 90 percent of the program’s cost. The question now is, do we turn down money that will boost our state’s economy and help hard-working families in our communities? 

Why . . .

As always, start with empathy and values. Explain the federal law as simply as possible and define the issue as a choice between accepting or rejecting the proffered federal funds. Do not make this a choice of whether or not to expand Medicaid. The word Medicaid turns off voters because it brings to mind negative thoughts—of bureaucracy and welfare. Once you have set up the choice between accepting and rejecting federal funds, make your case. 

Say . . .

Our state should accept the money; it will benefit everyone. It will energize our local economy and create thousands of new jobs. It will save millions in taxpayer dollars that are currently spent treating uninsured people in emergency rooms. And most important, we all know hard-working people who are hurting financially, including friends and family. We should not turn down the federal funds and deny them the security of quality health coverage. 

Why . . .

As we have explained above, when you argue for any policy that tends to benefit low-income Americans, explain that your listeners—or their friends or families—also benefit from the policy. Make it clear that Medicaid expansion benefits everyone. Right wingers want to pit voters (almost all of whom have health insurance) against the uninsured. Don’t let them succeed. 

Don’t say . . .

Say . . .

The poor, people in poverty

Give rights or benefits

Expand a government program

Hard-working Americans

Don’t deny rights or necessities

Security

Why . . .

Generally avoid language about poverty because it evokes negative ideas of welfare in voters’ heads. These monologues refer to hard-working people because it means recipients deserve basic medical coverage, and they say “don’t deny them the security” instead of “provide them the security” because persuadable voters are always more strongly moved by an argument about protecting people from being denied something than one about giving or providing that same right or benefit.

Right wing argument: This will require higher taxes and our state can’t afford it. 

Say . . .

It will not require higher taxes and, in reality, we can’t afford to turn the money down. The federal government will pay the entire bill through 2016 and even after that the economic benefits to the state will be greater than the costs. This deal will benefit everyone in our state, both now and for the long-term. 

Why . . .

The health care expansion “will reduce state and local government costs for uncompensated care and other services they provide to the uninsured, which will offset at least some—and in a number of states, possibly all or more than all—of the modest increase in state Medicaid costs,” explains the Center on Budget and Policy Priorities. In addition, the state will get millions in new sales and income taxes from the use of the billions of dollars coming in.

Right wing argument: This is a partisan issue, only Democrats favor this. 

Say . . .

Ohio Governor John Kasich, New Jersey Governor Chris Christie, and Arizona Governor Jan Brewer are just a few of the many Republicans who favored accepting these federal funds. It’s because they understand it’s a good economic deal for the state and for all its citizens.

Right wing argument: This is more big government and Americans oppose that. 

Say . . .

Residents favor this health care expansion—polls show they want us to accept the federal funds. They support it because they understand it benefits everyone in our state. 

Right wing argument: There is so much fraud in the Medicaid program, we’ll just be wasting our money. 

Say . . .

I strongly oppose wasting money and that’s one big reason we should participate in this program. Millions of taxpayer dollars are currently wasted treating uninsured people in expensive hospital emergency rooms. We can fix the problem by accepting federal funds so people can get their medical care in a cost-effective way from doctors in their offices. 

Right wing argument: The federal government has promised money that it doesn’t have. Sooner or later, the federal government will renege on its commitment and leave the states to fund this on their own. 

Say . . .

The Affordable Care Act reforms our nation’s inefficient and wasteful health care system in a way that will save the government hundreds of billions of dollars. So this expansion in coverage will be continued because it saves money. But even if funding were cut sometime in the future, our state is allowed to pull out at any time. There is no downside to accepting the money. 


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