Matt Bevin, the newly elected Republican governor of Kentucky, says his state can’t afford to keep covering the people who have gained health insurance through Medicaid expansion. If money really is the issue, Bevin may find that Kentucky can’t afford not to.

The Affordable Care Act lets states extend Medicaid coverage to anyone earning up to 138 percent of the poverty level (this year, $33,465 for a family of four), with 90 percent of the cost paid by the federal government. So far, 30 states and Washington, D.C., have done so, providing health coverage to some 12 million more people.

They’ve done this at rock-bottom cost, because Medicaid is one of the least expensive ways to provide insurance. For every newly enrolled adult last year, the Medicaid coverage cost $5,517, almost 10 percent less than the average premium for employer-sponsored health insurance.

Opponents of expansion contend that, even so, the states’ 10 percent share is too much to bear. Without question, that cost is significant. But Bevin and like-minded Republican officials in other states are wrong to conclude that cutting it will save them money.

That’s because looking at the state expense in isolation ignores the economic impact of the other 90 percent. Every dollar the federal government spends on health care in Kentucky is a dollar of revenue for hospitals, doctors and other health care providers. In the past year, Alaska, Montana and Indiana have overcome their reluctance to sign up. Before taking his state in the opposite direction, Bevin should look closer at the problem he’s trying to solve.


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