So what happens with Medicaid?

This will be the next big fight, but will take place on the state level. Republican governors may try to sabotage the health care act by insisting they won’t take the federal money for Medicaid expansion, but don’t underestimate the political pressure that will be exerted by voters who want what other states have. (Don’t forget that many of the reddest states are very poor and heavily dependent on programs like Medicaid.):

For many people without insurance, a key question raised bythe Supreme Court’s decision today to uphold the Affordable Care Act is whether states will decline to participate in the law’s big Medicaid expansion.

Although the court upheld the law’s mandate requiring individuals to buy insurance, the justices said the act could not force states to expand Medicaid to millions by threatening to withhold federal funding.Republican leaders of some states already are saying they are inclined to say thanks, but no thanks.Tom Suehs, the Texas Health and Human Services Executive commissioner whose state could cover an additional 1.8 million people by 2019, praised the court for giving “states more ability to push back against a forced expansion of Medicaid. The court clearly recognized that the Affordable Care Act put states in the no-win situation of losing all their Medicaid funding or expanding their programs knowing that they would face billions of dollars in extra costs down the road.”

The act, signed by President Obama in March 2010, required “states to extend Medicaid coverage to non-elderly individuals with incomes up to 133 percent of the poverty line, or about $30,700 for a family of four,” according to a March 2012 report by the Center on Budget and Policy Priorities, a liberal think tank. The extension was expected to cover nearly 16 million people by 2019, one of the law’s main ways of reducing the ranks of the uninsured.

The 26 states that challenged the health care law together account for an estimated 8.5 million of those who would benefit from Medicaid’s expansion by 2019, more than half the total, according to ProPublica’s analysis of an Urban Institute report prepared for the Kaiser Family Foundation.

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 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.

6 thoughts on “So what happens with Medicaid?

  1. Yesterday, in a comment I left a WNYC’s Brian Lehrer Show, I was guessing that Roberts’ vote was more a favor for the big for-profit health insurance corporations, but I also wrote:

    “…I wonder what the fine print will show Roberts is saying and perhaps laying the groundwork for: Ways to limit the power of the Federal government to create universal health care…?
    ~~~Jun. 28 2012 10:42 AM”

    I’d say he’s looking way beyond mere health insurance legislation: He’s looking at killing the New Deal –FDR through LBJ– by using judicial activism.

    After reading and hearing more about the decision, I’m now certain Roberts joined the 4 justices in favor of the Obamacare legislation due to first and foremost his desire to take on Congress’s constitutional right to use the Commerce Clause as defined during the New Deal years. That is real objective: To undo New Deal, wherever and however possible.

    His second objective was, yes, to grant some big corporations a boon, as he views government as a means to assist the profit making ability of entities (aka corporate persons) and the wealthy.

    Third, he wanted to make crystal clear that the mandate was a tax and that aids the Republicans in going after Obama and Democrats this election cycle. This may aid him in getting more justices who think as he does, and then the dismantling of all the great social safety net legislation can begin in earnest. An offshoot of calling the mandate a tax in tandem with his wording about the Commerce Clause is to move any social legislation into the tax increase arena, where the Republicans know how to fight it and have done so successfully. The R’s will paint all the enabling legislation for Obamacare as new taxes going forward, even more than they’ve done already. This will assist them in killing or disabling the actual implementation of Obamacare! They’ve done this with the SEC, the Dodd-Frank new banking regulations, etc. Not a new tactic for them.

    Roberts is not a centrist hero; he is a rightwing tactician and leader in changing how our constitution can be read and used in the future. He also plays a long, long game, putting in wording and laying groundwork for decisions in the future which will overturn much of what has been done in the last three quarters of the 20th Century.

    Sarcastically, I see him as wanting to take us back to somewhere between pre-Magna Carta and the Gilded Age.

    Not so sarcastically, he absolutely wants none or as little as possible of that real Progressive legislation of the early 20th C. to remain and he wants to drive a wooden stake through the heart of the New Deal and following New Deal inspired legislation.

    Time will tell — and Roberts has lots of time left on the court.

  2. I don’t think that the opposition governors will pay attention to any sentiment from the uninsured who will be left out because the state refused to expand Medicaid. In West Virginia the pressure is already on to reduce and limit Medicaid from what it already is. The only pressure will be to resist paying anything more to people who are perceived to be suffering the deserved consequences of their own failure. Plus, they are also privatizing Medicaid by turning its management over to HMO’s who are already cancelling contracts with certain local hospitals to cut costs.

    There are already quotes floating around ( from our former governor, now senator (God help us) Joe Manchin indicating that he does not like the Medicaid expansion one bit, and what senator Manchin does not like governor Tomblin will not like either. Neither one is going to the democrat convention to show their displeasure with the president.

    Susie, I am glad that this law has helped you, and for that I am grateful it still stands. But I don’t see it making one bit of difference for my life. Even if I get an insurance policy, I doubt that I will be able to afford the deductibles and co-payments to us it.

  3. Our constitution divides power between the federal government and the states, just as it divides power among the three branches of the federal government. For split sovereignty to work, both the states and the feds must be able to make independent decisions within their respective spheres.
    The ACA attempts to crack the constitution by directing and empowering administrators in the U.S. Department of Health and Human Services (HHS) to effectively bankrupt any state that makes Medicaid decisions different from those approved by the federal government. First, the ACA imposes costly new requirements on states for Medicaid spending, overriding any state choice to the contrary. The federal government has promised to pick up some of the tab, but given the disastrous federal financial situation, it is unclear how or whether this will happen. Whether or not it does, the feds will be unloading huge new expenses onto state taxpayers. Second, if a state does not comply with federal instructions to the letter, the ACA gives HHS virtually unrestrained authority to stop any and all Medicaid funds to that state.
    Medicaid is not some minor state-federal program. It is the largest item in most states’ budgets ( ).

  4. Wow. So not only are you factually wrong (SCOTUS ruled against tying Medicaid funds to ACA Medicaid expansion, and the ACA funds are already approved), but you’re parroting extremist talking points in hopes of winning Engage America Reward Points! That is so cute.

  5. Engage America Rewards Points? That’s new one for me and see get all kinds of stuff on Social Media and emails from Right of the Dial….
    Did a quick check and those points have been cut and pasted all over the intertubes…
    But, have to say at least Mizz Carley did give a link, and most folks Right of the Dial won’t do that……

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