Lost in much of the pol itical analysis of the U.S. Supreme Court’s landmark health care ruling is the power the court gave to the 50 state governors.
It was a small consolation prize for many governors who had opposed the Medicaid expansion and the mandate that Congress placed upon the 50 states as part of the health care reform.
Gov. Rick Scott made clear he would exercise the power given to him by the high court — the power to refuse a costly Medicaid expansion without fear of reprisal in the form of withdrawal of basic federal Medicaid funding. Scott told Fox News that he would not expand the Medicaid program because the Sunshine State would have to come up with new Medicaid funding that it doesn’t have.
Scott won’t be the last governor to opt out of the Medicaid expansion, a key part of President Barack Obama’s Patient Protection and Affordable Care Act. But he was one of the first to say he plans to opt out, and that’s not surprising.
For one thing, the state was one of the first to sue the federal government over the health care mandates. Also, Florida lawmakers know full well that their budget problems get worse — much worse — if the state portion of Medicaid continues to balloon.
Scott said Obama’s plan for the states to expand Medicaid and set up market “exchanges” to find private health insurance for the uninsured would cost too much money.
Medicaid now exceeds what the state spends on public education. The state will spend about $21 billion on Medicaid this budget year — that’s about 30 percent of the state’s $70 billion budget. Spending on public schools, by comparison, totals $17.2 billion, or 25 percent of the budget.
Expenses were bound to rise in 2014, when the federal government, via the Affordable Care Act, asks the states to cover everybody with incomes below 133 percent of the poverty line — or about $30,000 for a family of four, according to National Public Radio.
Many states will balk at that, even with additional federal money.
It’s time for Congress to examine reforming Medicaid as a whole. U.S. Rep. Paul Ryan, R-Wis., the House Budget Committee chairman, has drawn praise for his proposal to give states a block grant for Medicaid and let them tailor their programs. That is just one of many promising ideas for Medicaid reform.
For now, the ruling within the ruling takes away the federal government’s implicit threat that if states didn’t go along with the Medicaid expansion, they would lose federal money for existing Medicaid programs. The courts ruled the federal government couldn’t coerce the states in such a manner. Medicaid is voluntary with the states. States can opt out completely if they like. Most states would never want to do that even if, like Florida, they refuse to expand the program as part of Obamacare.
The Panama City News Herald