The Coming Medicaid Battle

The Supremes speak… and America scrambles.

The Supreme Court ruling on Obamacare now presents Virginia with a huge decision. While most attention has focused on the legality of the Obamacare “mandate,” the Supremes also determined that Congress cannot compel the states to participate in the expansion of Medicaid. Thus, the General Assembly will have to decide whether or not Virginia will participate.

The Affordable Care Act expanded Medicaid to cover all adults below 138 percent of the federal poverty level beginning in 2014. Uncle Sam will pay the tab for this expansion through 2016, but then the states will pick up an increasing share of newly added costs, culminating with a 10% share in 2020.

In a 2010 study, the Heritage Foundation contended that the measure would expand Medicaid enrollments by $18.4 million people nationally, and by 389,000 in Virginia. The cumulative cost to state government nationally would be $33 billion between 2014 and 2020. Virginia’s share would be $754 million.

The Washington Post sums up the states’ dilemmas this way:

“States are going to weigh leaving huge amounts of federal dollars on the table, versus accepting potential exposure from expanding an entitlement program. … You used to just have to hold your nose because you had to do it. Now, every state is going to have to make some aggressive calculations.”

Those calculations pretty much boil down to two incentives, pulling in opposite directions. On the one hand, there’s a deep pot of federal money for states to expand their Medicaid programs. On the other, there’s the fear of getting even more saddled with bills from an increasingly expensive entitlement program.

Interestingly, Virginia was one of the states that did not argue against Medicaid expansion in the Supreme Court suit. However, Virginia Republicans seeking to roll back any piece of Obamacare that they can surely will contest it. Medicaid will become the budgetary battle royal of the 2013 legislative session.


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  1. larryg Avatar

    I think SCOTUS was CORRECT in saying that existing monies cannot be taken away if states don’t sign on to new MedicAid programs but if the Feds are initially covering all or most of the coverage – how is that different than the current program where the states have voluntarily signed up to MedicAid – and can opt out?

    For better or worse – the states by signed up for MedicAid as well as the expanded programs get substantial funding (some would say recouping taxes collected on their citizens) …. with strings attached.

    Talk about “coercion” !!!

    Each state DOES have the option of going it alone on how they care for those who are not able to care for themselves. That would be kids of poor parents, the physically and mentally incapacitated and the elderly who need assisted/long term care.

    Each state has the OPTION of setting up a system to do this that would include means-adjusted premiums and/or similar to how we handle car insurance for the uninsured.

    Virginia could back out of MedicAid if they wanted to. Instead, they chose to demonize it on less than honest pretenses pretending that they could but loath to not get those Fed dollars.

    Virginia COULD show LEADERSHIP in demonstrating that we don’t need no STINKIN Govt-controlled MedicAid but the Imperial Clown Show is as feckless as they appear to be. Even McDonnell could show some backbone here but alas most parties have no spine for it and prefer to demonize the Feds, Obama…anyone they can shift the focus to.

  2. Looks to me like how drug dealers hook people. “Here, take this free federal money for expanding Medicare. But you’ll need to pay for it later.” Thanks, but no thanks. Watch the Bozos, Fred Hiatt and Lee Hockstader, have hissy fits about this.

  3. larryg Avatar

    but isn’t this about how Va will choose to care for it’s vulnerable? Why do we demonize the Fed money if the entire program is voluntary to begin with?

    MedicAid has strings but there is also quite wide latitude in the ways the states can administer and operate the programs.

    Virginia has a responsibility to care for it’s vulnerable. They can choose to do it through MedicAid or not. Virtually all the people on MedicAid are kids, the handicapped and the elderly.

    and yet we “blame” the Feds for offering MedicAid as voluntary option.

    it makes no sense. If we don’t want to care for our citizens using Fed help, then opt out. Texas has threatened to. Why not just separate from the Fed on it?

  4. Unlimited needs with limited resources. If a state doesn’t think it can keep up the funding necessary to support the Medicaid expansion, it probably shouldn’t expand the program.

  5. larryg Avatar

    well I agree but in the end, we’re talking about people who do not have insurance and WILL show up at the ERs when they get sick – get treated at elevated ER costs – that will then be transferred to those who do have insurance.

    We seem to think that the question is whether or not we want to pay for those who cannot afford care – as opposed to how much we WILL pay and whether or not ER care is cheaper than MedicAid Care.

    If we actually had a system where those without insurance would be turned away from the ERs, we could, in reality, believe we were avoiding those costs but until /unless we repeal EMTALA – we are living in denial.

    People without insurance do not – not get care. They get the care, at elevated costs, …that we pay.

    Are we so blinded by our refusal to want to pay for MedicAid that we would continue to believe that by not paying for MedicAid that we are not paying for those who need care?

    It’s almost as if we ARE willing to pay the higher costs as long as we don’t have to actually admit that we are paying for the care of the uninsured anyhow.

    At this point, the politics seem almost comical except that they are very real.

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