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What you didn’t know about Medicaid in 2013 (let alone 2014)

Preventive care got a boost on Jan. 1. It's not even in dispute.

Did you know that sometimes there is a free lunch — or, more precisely, free money?

If not, then let me guess: You haven't finished reading the 900+ pages of the Affordable Care Act, even though this was one of your New Year's resolutions. And maybe you've woken up in the middle of the night wondering: What's in it for public health?

Okay, I realize that is not a likely scenario. But should you be curious, a summary of the key public health provisions can be found here.

Right, even with a simple eight-page summary, you aren't going to sit down and read it. So how about just the two updates, one paragraph apiece, on the latest, low-profile provisions to kick in, on Jan. 1, 2013?

Or let me just explain them to you:

  1. "Increasing Access to Affordable Care and Improving Care and Lowering Costs," allows states to cover specified preventive services to Medicaid adult enrollees and gives states federal matching funds to provide these services. Translating from the government prose, this means paying to prevent disease rather than merely treating it — a core principle of the Affordable Care Act and the best of public health practice. Medicaid details are here.

  2. "Increasing Access to Affordable Care" requires states to pay primary care physicians no less than 100 percent of the Medicare payment rates for primary care services. The federal government covers the increase. In simple language this means that we are going to pay primary care doctors enough to keep them practicing what they do best — providing quality, preventive care — rather than driving them out of effective programs by paying them too little, as is currently the case. (Specialists in various treatments already get more.)

Beyond the new measures, which are in place everywhere, looms a larger – and far more publicized and polarized – issue: Will states expand Medicaid eligibility to more residents by raising the threshold of eligibility to 138 percent (technically 133 percent, with 5 percent leeway) of the federal poverty level. Coverage for the newly eligible adults will be funded entirely by the federal government for three years, beginning in 2014, phasing down to 90 percent by 2020, with the states responsible for no more than 10 percent of the added cost. The financing arrangement is described here. Currently, 19 states have signed up for the Medicaid expansion.

Delaware is one of them. Many analysts believe that New Jersey Gov. Christie's past comments mean he will opt not to participate in the Medicaid expansion, although Democrats in his heavily Democratic state are pushing him to go the othe way. Just last week Pennsylvania Gov. Corbett said publicly that he cannot recommend his state's participation at this time but legislators in Harrisburg will soon be taking up the question; a campaign that seeks to convince them to break with Corbett kicks off Tuesday, Feb. 12, at the Capitol. With both houses firmly under Republican control, advocates may have an uphill battle. Around the country, however, not all decisions are falling along partisan lines. The day before Corbett's statement, Gov. John Kasich of Ohio became the fifth republican governor to propose expanding eligibility.

Since residents of New Jersey and Pennsylvania send money into the federal coffers through income taxes, Medicaid expansion would be a great way to get some of those dollars back. But debate is heated, as a quick look at recent local articles and commentary on the issue will tell you. The coverage of this controversy is worth reading.

Ninety-nine percent of the time when you hear the promise of "free money," the offer is too good to be true. But with the federal government offering support to expand health care to our low-income fellow citizens it seems prudent for states to sign up. If the offer of free money isn't enticing enough, then consider acting out of self-interest. People with coverage are going to get preventive care. That means they'll be less likely to spread contagious ailments and, by staying healthy, won't burden everyone – themselves and all the rest of us – with the cost of expensive medical care.

In 2013, the Affordable Care Act expands prevention services within Medicaid for those who are currently eligible for the program. It is up to us to see that Pennsylvania and New Jersey expand access to Medicaid for hundreds of thousands more of our neighbors.

Janet Golden, a Rutgers University history professor, specializes in the histories of medicine, childhood and women.

Read more about The Public's Health.