States’ Last Ditch Stand Against Federal Medicaid Expansion

There is one certain means by which one can be sure never to see a country’s ruin. I will die in the last ditch.

William III (1650-1702), Hume’s History of England

At its core, Obamacare is a massive entitlement expansion. Between vastly increasing Medicaid eligibil9ity and new premium subsidies, it is expected to bring 30 million more people onto the federal government’s entitlement rolls. Rhe alw anctipates that the states will take on the burden and implement the expansion, but the states can opt out of both.

“Capretta and Levin: Why Obamacare Is No Sure Thing,” Wall Street Journal,  November 18, 2012

November 19, 2012 -  In their gloating over President Obama’s decisive electoral college victory, Democrats may think the road to Obamacare implementation has been cleared. 

They are missing several realities.

1.  30 states have Republican governors, 

2. 20 of these states have said they want nothing to do with Medicaid expansion.

3. the employer mandate to refer patients to these exchanges may be on itw way to the Supreme Court.

4. Chief Justice Roberts decision of the constitutionality of the individual mandate allows to opt of federal Medicaid expansion.

The exchanges would provide for greater subsidies  than those of employer plans.  This would increase state Medicaid costs.  Also federal exchanges would enforce federal law and regulations, vastly increasing Medicaid costs for states.  By declining exchanges,  states would pass the burden and expense of setting up exchanges and implementing them back to the federal government – where they belong.

There is another factor as well.  The influx of 30 million more Medicaid recipients flies in the fact of the escalating doctor shortage. Further, 50%  of doctors no longer accept new Medicaid patients because of low reimbursements and often indecipherable time-consuming regulations.

The states prefer a block grant allowing them to provide benefits more efficiently than the muscle-bound federal government, which has difficulties getting out of its own way.

Tweet:  Obamacare has a rough row to hoe if it expects state govenments to passively implement health exchanges that would bankrupt them.