ENGLAND, Ark. As a construction worker and logger, Bryan L. Mashburn does what he describes as backbreaking, muscle-pulling work, laying concrete foundations for water towers and felling 3,000-pound trees. He has no health insurance, and he tried to avoid going to doctors when he crushed a finger on one occasion and metal shavings flew deep into his eye another time.

Brian Mashburn, 39, is a construction worker and logger without health insurance. Changes in Medicaid scheduled to occur under the new health care law will help people like Mr. Mashburn gain access to affordable health care.

Mr. Mashburn, 39, is exactly the kind of person who stands to benefit from changes in Medicaid scheduled to occur under the new health care law a vast expansion of the program that is expected to add 250,000 people to the rolls here in Arkansas and 17 million across the country.

The expansion of Medicaid if it is upheld by the Supreme Court is among the most significant parts of the law, as it will provide coverage to people with the greatest financial needs. Many health care advocates support the expansion, saying it will allow poor people to receive needed care, while many state officials, especially Republicans, worry that it will bring budget-breaking new costs.

The expansion may also strain the health care system, given the shortage in some places of primary care doctors, who will be vital to expanded coverage.

The Supreme Court, which is expected to rule on the health care law this month, devoted more than an hour of argument to the Medicaid provision.

Arkansas illustrates not only the potential benefits but also the major challenges facing states as they plan for a larger Medicaid program. The state does not have enough doctors and other health care workers to care for all the new beneficiaries, experts say, and state officials worry about the costs.

The expansion of Medicaid is a sea change, and its occurring at the most difficult fiscal time in the history of the program, said the Medicaid director in Arkansas, R. Andrew Allison, who is the president of the National Association of Medicaid Directors. States are preoccupied with the challenge of sustaining the Medicaid program we already have.

Arkansas officials have discussed cutting Medicaid services in the coming year to help close a gap between Medicaid costs and expected state appropriations. The gap up to $400 million represents more than one-fourth of state spending on the program.

Medicaid is jointly financed by the federal government and the states, with Washington paying 50 percent of the costs in higher-income states and about 70 percent in lower-income states like Arkansas. States have historically had leeway to define eligibility and benefits within guidelines set by federal law.

Read the rest here:

In Health Care Ruling, Vast Implications for Medicaid