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Originally published September 12, 2012 at 8:03 PM | Page modified September 12, 2012 at 9:41 PM

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Truth Needle: McKenna's right on Medicaid — to a point

Gubernatorial candidate Rob McKenna says one in three Washington residents would be eligible for Medicaid under the expansion allowed by the federal health-care law. That's true, but there is more to the story.

Seattle Times staff reporter


The claim: During a recent debate, Republican gubernatorial candidate Rob McKenna questioned whether the state should expand its Medicaid health-insurance program to include more low-income adults, as proposed under the federal health-care overhaul. McKenna said: "Under the new standard in the Affordable Care Act, nearly one in three Washington residents — one in three — would be eligible for Medicaid. Is that the future we want?"

What we found: Mostly true.

About 1.6 million Washingtonians are now eligible for Medicaid. In a state with 6.8 million people, that's about one in four residents, and includes children; pregnant women; some low-income families; and certain aged, blind and disabled adults.

In about 16 months, the federal government will begin paying states to extend Medicaid coverage to adults under 65 years with family incomes at or below 133 percent of the federal poverty level. That's $14,856 a year for a single person, and $30,656 for a family of four, although adults without children are expected to make up most of the newly eligible.

The federal government will pay 100 percent of the costs for new enrollees for three years. That share would gradually decline to 90 percent by 2020.

States can refuse to extend their programs, and some governors have announced their intention to do just that.

If Washington accepts the money, it can expect about 494,000 Washingtonians to become eligible for Medicaid for the first time.

That would make one in three residents eligible for Medicaid. So McKenna's math is correct.

But he later erred in that same debate by equating eligibility with enrollment, questioning whether the state should have one of three people "enrolled" in Medicaid.

No one expects everyone who is eligible to enroll, and, even now, more than a half a million people who could be getting their health insurance through the state are not, according to a widely cited study commissioned by the state.

The study by The Urban Institute's Health Policy Center predicted that about half of the people newly eligible would actually enroll. Those people would generally be younger and healthier than those now in the program, according to the study.

The program also could expect a bump in enrollment from people who qualify for Medicaid benefits now but who, for a variety of reasons, are not enrolled.

All told, The Urban Institute predicts about 328,000 more people would enroll in the program if the Legislature approves the expansion.

That means that about one of every five Washingtonians — or 21 percent of the state's population — would be expected to receive health insurance through Medicaid. That number is now a little more than one in six.

Why the difference between eligibility and enrollment?

The Urban Institute study found that more than a third of the people who would qualify for the program already have private health insurance. That's also true for many of the people who could be receiving Medicaid now, but who aren't, according to the study.

Although some would likely abandon their private insurance for Medicaid, the study notes that, historically, people who have private insurance tend to stick with it even though they could be receiving Medicaid.

McKenna, who is now the state's attorney general, has questioned whether the state can afford to expand the program unless it gets more flexibility in how Medicaid is run.

Although the program is a state and federal partnership, the states have to follow federal rules to get federal dollars.

McKenna's challenger, Democrat Jay Inslee, favors expanding Medicaid to low-income adults as proposed, and he argued in the debate that everyone with insurance is already paying a high price to subsidize the uninsured.

The Medicaid expansion is the second major provision of President Obama's health-care initiative that McKenna has objected to.

In March 2010, the same day the Affordable Care Act was signed into law, McKenna joined other Republican attorneys general in filing a court challenge to the new law.

The U.S. Supreme Court upheld the private-insurance mandate but ruled that the federal government could not threaten states with the loss of Medicaid funds unless they went along with the expansion. That created the option now being debated.

McKenna said he joined the suit because he objected to the law's requirement that most Americans buy private health insurance by 2014. He also objected to the expansion of Medicaid, likening it to "creeping socialism." He softened that at one point, saying he was prepared to expand the program as governor. But in a recent op-ed, he wrote, "We should not commit to any expansion until we have a willing federal partner, offering us flexibility to manage the program more effectively."

The federal and state governments are continuing to work out details.

McKenna said he wants the federal government to become more flexible in its payment arrangements so the state can pocket savings for becoming more efficient, but his campaign could not provide an example of how that would work.

While McKenna is correct that the new rules would make one in three residents eligible for the program, his failure to distinguish between eligibility and enrollment could give the impression that far more people would be getting their insurance through the state than are likely to if Medicaid is expanded. For that reason, we find his claim to be mostly true.

Susan Kelleher: 206-464-2508 or On Twitter @susankelleher.