Wednesday, January 16, 2013
Over the last few days, the European press has devoted significant attention to a euthanasia case in Belgium. According to the report by Reuters, the 45-year old identical twins, both deaf, had recently learned that they were losing vision as well. Marc and Eddy Verbessem had lived together all their lives and reportedly found it intolerable to imagine lives in which they could no longer hear or see one another, or continue to live independently. Family members tried to talk them out of the decision, but ultimately were with them when they died on December 14, 2012. Apparently they spent two years trying to find Belgian health care providers willing to perform the lethal injections. The case has been less noted in the US, but the Huffington Post blog has just published a very sympathetic account of the twins' decision.
Tuesday, January 15, 2013
Just last week, I gave a talk to a local seniors' group about the Affordable Care Act and changes to Medicare and Medicaid. One member of the audience asked me what Arizona was doing about the Medicaid expansion (lots of folks here in frozen Spokane, Washington spend time in Arizona during the winter). I said, somewhat facetiously, that I didn't know for sure, but I assume that if it is something that the federal government is offering the state, Arizona would say "no thank you." After all, Arizona didn't even join the Medicaid program until 1982, 17 years after the program was enacted. It was the last state to join the program. And Governor Brewer made her feelings about President Obama crystal clear in that famous photographed encounter on an airport tarmac in Mesa, Arizona, where they wagged fingers at each other.
Well, I join with the Arizona legislature in my surprise at Governor Jan Brewer's announcement yesterday that she will push for Arizona to expand Medicaid to childless adults making less than 138% of the federal poverty level. According to the Associated Press, even Republican leaders in Arizona's legislature were surprised by Governor Brewer's announcement, joining surprised journalists who were provided an advance copy of Brewer's speech without the section on the Medicaid expansion.
This speaks to what a good deal the Medicaid expansion is for the states, but it remains to be seen whether or not the Arizona legislature will agree with Governor Brewer. Governor Brewer did say that she would propose that any expansion of Medicaid would include a "circuit-breaker" that would roll back enrollment if federal reimbursement rates decrease from the current low of 90%. It remains to be seen if once a state expands its Medicaid program, it can disenroll from a portion of the program and continue to receive federal funding for the remainder of the program. Until the recent SCOTUS ACA decision, the answer would clearly have been no, but now it is unclear. The SCOTUS decided that the states could decline to expand their programs and must continue to receive federal funding for the pre-existing program, but that does not necessarily mean that the state can expand its Medicaid program for some period of time, and then disenroll from a portion of the program if the federal government changes the matching percentage. Another example of how the SCOTUS decision created at least as many questions as it answered for Medicaid and other cooperative federal-state spending programs.
cross-posted on Healthy Interests