Medicaid expansion, the latest political hot potato, landed squarely in Republican Governor Jan Brewer’s lap a few days ago. Her decision to endorse Medicaid shocked many conservatives, but her endorsement is logical if viewed through the lens of pragmatism.

As governor of Arizona, Brewer leads the state with the most controversy over legal and illegal immigration. She must ensure that financial protection for Arizonian citizens is at least equal to, if not greater than, the protection afforded to legal immigrants. Currently, due to a glitch in Obamacare, legal immigrants (and only legal immigrants) have access to more governmental financial assistance than low-income citizens, and this would not be a politically palatable scenario for Brewer.

Part of President Obama’s healthcare facelift includes a huge (but optional) expansion in Medicaid for states. States who expand Medicaid will receive millions of federal dollars to fund healthcare for an increased population of citizens (approximately 17 million nationwide) who will now become eligible for aid. By accepting and endorsing the Medicaid expansion, Brewer not only secures millions of federal dollars for low-income citizens in her state, but she also ensures that they have as much access to governmental financial assistance as legal immigrants.

The disparity between citizens and legal immigrants occurred when Congress, as part of the Patient Protection and Affordable Care Act, legislated that citizens who have coverage deemed affordable by the law will be ineligible for government subsidies on the new health insurance exchange markets. This would be logical if the law’s definition of “affordable” truly applied for every family, but of course it does not. Many families will be unable to pay the premium for employer coverage even though the law thinks they can, leaving Medicaid as their only option.

How is this related to immigration? Well, in a separate battle for legal immigrants who normally have to wait five years to qualify for Medicaid, a suitable middle ground was found. While they waited to qualify, immigrants could get government-subsidized private coverage in the new health insurance exchanges, an option not given to citizens living under the federal poverty level, since citizens will automatically be eligible for Medicaid.

That doesn’t seem so bad, until the third piece of the puzzle is connected. The Affordable Care Act assumed that all states would expand Medicaid. Thus, states could provide Medicaid benefits for all eligible families who could not otherwise afford health care coverage. However, the Supreme Court’s decision to make the expansion of Medicaid optional for states means that those states that opt out leave low-income citizens high and dry while low-income legal immigrants will still be able to receive government subsidies.

Although it seems improbable that such a gaping oversight was not caught sooner, Congress and the White House acknowledge that the Affordable Care Act leaves a loophole for legal immigrants who remain exempt from restrictions on government subsidies. The usual passing of the baton begins with the White House declaring no power to change law and Congress being unwilling to redress its misstep. The Internal Revenue Service has been a voice of reason: families who cannot get coverage because of the glitch will not face an IRS tax penalty for remaining uninsured. So far, only the IRS has taken steps to mitigate this issue using regulatory pathways.

Aside from this legal quirk, which is a confusing flourish that will likely remain in the annals of Congressional legalese, other states that have already endorsed Medicaid strengthen Governor Brewer’s position. For example, the Republican governors of Nevada and New Mexico have endorsed Medicaid, which comes as no surprise since these two states also deal with immigration issues. Other conservative states are also beginning to see the economic benefits, especially since the federal government promises to fund the expansion for the first three years.

Do we need to implement other options to fix Medicaid in the long run? Undoubtedly. Yet, as Missouri Governor Jay Nixon said, “none of those [options] are possible [without] the money and the expansion.” He is not the only one who wants to move forward: as of now, 26 states, the District of Columbia, and many hospitals nationwide support expanding Medicaid. While the Medicaid expansion is far from perfect, it is a step in the right direction—a paradigm shift in politicians’ and the public’s willingness to replace failed methods with new experiments. By endorsing Medicaid, Brewer made the right decision.

 

Reach Contributor Diya Dwarakanath here.