Expanding Medicaid

County leaders are waiting for more guidance from their states and are hoping that they will not bear the brunt of policy changes, says Commissioner Larry Johnson of DeKalb County, Ga., who was recently appointed chair of the health steering committee for the Washington-based National Association of Counties. “We haven’t started a whole process in Georgia,” he says. “We are waiting for the outcome of the [November] election before engaging on policy.”

With a large county hospital under his jurisdiction, Johnson says that he would like to see broader coverage under Medicaid. “Medicaid expansion would help a great deal with the uninsured,” he says. Even more important, from his point of view, is that changes do not push more responsibilities onto counties without additional resources to pay for the new expenses. “I would not like to see unfunded mandates come to the county,” he says.

Cook County, Ill., President Toni Preckwinkle (D) says that the state has given the county its approval to pursue immediate federal reimbursement for uninsured recipients in advance of the official inception of the Medicaid expansion. “We’re proceeding full-steam ahead,” she says, “and we’ll pray for a favorable outcome in the fall.”

In Skagit County, Wash., Commission Chair Ken Dahlstedt has a triple dose of uncertainty. Not only does he have to await the outcome of the national elections and a governor’s race in his own state that has seen Medicaid expansion become one of the driving issues, he himself is up for re-election. “It’s a challenge for the county,” he says. “We’re at the bottom of the food chain.”

He says that uncompensated care at the county’s three community hospitals has had a huge impact on the county budget, but that the question will remain unanswered until the fall. “It’s the atmosphere of chaos in which we live,” he says.