Gambit: July 10, 2012

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Stanford University health economist Dr. Jay Bhattacharya  wrote on Stanford’s medical school blog that some states may  opt out. “Cash-strapped states will almost certainly consider  this option, since they will ultimately be on the hook for financing  at least a portion of this expansion,” he wrote. “If enough states  decide to deny the Medicaid expansion, this may substantially  reduce the ability of ACA [the Affordable Care Act] to expand  insurance coverage.”     Medicaid is a joint state-federal program that provides   health coverage to the poor and disabled, with states putting   up a portion of the money and the federal government funding  the rest. Each state’s matching percentage is based on per  capita income.     According to a separate Kaiser Family Foundation report,  “Medicaid currently provides health coverage for over 60 million  individuals, including 1 in 4 children, but low parent eligibility levels and restrictions in eligibility for other adults mean that many  low income individuals remain uninsured. The ACA expands  coverage by setting a national Medicaid eligibility floor for nearly  all groups.”     Under the law, the federal government would cover nearly 93  percent of the costs of the Medicaid expansion from 2014-22,  according to the Center on Budget and Policy Priorities. “Specifically, the federal government will assume 100 percent  of the Medicaid costs of covering newly eligible individuals for  the first three years that the expansion is in effect (2014-16).  Federal support will then phase down slightly over the following  several years, and by 2020 (and for all subsequent years), the  federal government will pay 90 percent of the costs of covering  these individuals. According to CBO, between 2014 and 2022,  the federal government will pay $931 billion of the cost of the  Medicaid expansion, while states will pay roughly $73 billion, or  7 percent.”     States that challenged the law argued that it was coercive  to require them to either expand Medicaid or risk losing all  Medicaid funding, a practical impossibility given the size of the  program in most states. The court ruled that while it was constitutional for Congress to offer states money to expand Medicaid,  it could not take away funding for their existing program if they  declined, according to SCOTUSblog.     Immediately after the ruling, some Republican state officials  said they were inclined to reject the new federal money, although  there has been no deadline set for doing so.     In Missouri, according to The Associated Press, “House Majority Leader Tim Jones says the Republican-led legislature will  not consider the expansion. Republican Lt. Gov. Peter Kinder  called the Medicaid expansion a ‘break-the-bank provision.’”     The Birmingham Business Journal said “opting out of the  Medicaid expansion seems increasingly likely for Alabama  — though Medicaid officials said they were still reviewing the  court’s ruling.”     After all, Alabama Gov. Robert Bentley said, “The health care  law is an overreach by the federal government that creates   more regulation, bureaucracy, and a dramatic increase in costs  to taxpayers.”     South Dakota Attorney General Marty Jackle was likewise  blunt: “I am relieved that the act’s Medicaid expansion has been  declared unconstitutional and has been significantly limited by  the court.”     That said, rhetoric does not always translate to action. Many  Republican governors said they would not accept funds from  the 2009 stimulus package, but they ended up taking the money  in the end. Three governors, in Florida, Wisconsin and Ohio,  turned down money to build a high-speed rail line. Former South  Carolina Gov. Mark Sanford tried to turn down federal education  stimulus money, but his state Supreme Court rejected that. And  former Alaska Gov. Sarah Palin rejected some state energy funding, but her state legislature overruled her.  ProPublica reporter Michael Grabell contributed to this report.


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Gambit: July 10, 2012 by Gambit New Orleans - Issuu