States figuring out price tags of health-care reform

As health-care reform is implemented, states are still struggling with basic questions: What does it mean for us, and more importantly our budgets? "With estimates ranging from state savings of $1 billion to $27 billion in additional costs, the one thing clear about health-care reform is that little, if anything, is actually clear," Jake Grovum reports for Stateline.org. The political rhetoric of the health-care debate gave way to technical questioning at a recent meeting of state health officials in Washington, Grovum reports, and led Washington state Medicaid Director Doug Porter to conclude, "There’s a lot about this bill that’s yet to be determined."

"It’ll probably be 10 years before it all shakes out," Chris Whatley of the Council of State Governments told Grovum, who writes that Whatley was only half-joking. "This will push the fabric of the state-federal relationship in new directions, and we don’t know how it will all come out." Much of the confusion rests on the law's interaction with 50 different existing state policies. All states will be required to set their Medicaid eligibility level at 133 percent of the federal poverty threshold. States classified as "expansion states" because they already allow Medicaid eligibility above 133 percent will be face with more investment up front but less over time. "For the most part, it’s better to be a non-expansion state," Grovum concludes.

Judy Solomon, a health policy expert at the Center for Budget and Policy Priorities, told Grovum it's too early to put a price tag on individual states' efforts to meet the new requirements, and too many variables prevent a confident prediction. That warning hasn't stopped Texas from claiming the law will cost it $27 billion between 2014 and 2023, which is $7 billion more than the Congressional Budget Office estimate of the cost to all states combined between 2010 and 2019, Grovum reports. Texas will undoubtedly face one of the largest bills, since it has some of the strictest Medicaid eligibility rules, but many disagree with the state's estimate, saying it ignores the reduction in costs for caring for the uninsured. (Read more)