Now it’s Christie’s turn to decide on expanding Medicaid and his decision should be easy

The Field Clinic is pleased to welcome two new guest bloggers who will be contributing on a regular basis, Dr. Drew Harris and Dr. David Nash of the Jefferson School of Population Health. Both are renowned experts on health policy and the American health care system. This is Dr. Harris's inaugural entry.

Governor Christie must soon decide whether New Jersey will expand its Medicaid program under the provisions of the Affordable Care Act ("Obamacare"). Now that Governor Corbett has moved to turn it down in Pennsylvania, at least for now, the pressure is on him to act.  Will he follow Corbett's lead or chart a separate course?

Expansion is a good deal for the state. At first, the federal government will pay all of the additional costs, with the state's share rising to 10% after three years. For some of the estimated 177,000 uninsured citizens who will receive health coverage, this could mean the difference between life and death.

A study published in the New England Journal of Medicine last July, found that mortality decreased 6.1% in states that expanded coverage to include childless adults when compared with neighboring states that didn't. The benefits were greatest for older adults, nonwhites and residents of poorer counties. The number of people who delayed care because of cost dropped 21.3% and rates of people self-reporting their health as "excellent" or "very good" increased 3.4%.

A Medicaid insurance card provides you with the resources to get a headache checked before undiagnosed high blood pressure causes a stroke. Chronic thirst, numbness, changes in vision and other early signs of diabetes requiring medical evaluation no longer have to be ignored because the rent is due. Health coverage makes timely treatment possible.

Health insurance saves lives. One study put the number of deaths associated with lack of health insurance in the US at over 44,000 per year. As medical science advances, the amazing array of effective treatment options has grown for those who can afford it. The difference in health outcomes between the insured and uninsured has also grown. We are a nation of medical haves and have-nots. Few can pay out of pocket for everything the system has to offer. For the rest, it's health insurance that makes the difference.

The Affordable Care Act achieves in part its primary goal of insuring more Americans by increasing the number of poor and near poor eligible for Medicaid. However, the recent US Supreme Court decision gave every state the option to opt out without penalty. Medicaid, the government insurance program for low-income people, is a partnership between the federal and state governments. Since Medicaid's inception in 1965, the feds picked up a large share of the cost. New Jersey as a wealthy state must match 50%. Poorer states get by with paying much less of the cost. So compared to traditional Medicaid, a future 90% federal match is a much better deal for the state. Needy people get an insurance card and New Jersey taxpayers pay pennies on the dollar.

An analysis by New Jersey Policy Perspective estimates that if the Governor signs off on the Medicaid expansion the state will receive $10.7 billion in federal funds in the first five years. Much of this will cover low-income workers in the service and construction trades—groups that have traditionally high rates of uninsurance. These funds will significantly offset part of the state's charity care costs. In 2011, the New Jersey hospitals provided $1.3 billion in uncompensated care for low-income and uninsured patients for which they were reimbursed $675 million from the state budget.

The decision before Governor Christie should be easy. For a relatively small investment at least three years in the future, New Jersey will provide needed health care to low-income workers who are putting off the primary care and early treatment that keeps them healthy and ultimately costs all of us money. The Governor should do it.

-          By Drew Harris