As I mentioned last week, when the Supreme Court upheld the constitutionality of the Affordable Care Act (a/k/a Obamacare) by a 5-4 vote, the Court also, by a 7-2 majority, struck down that section of the law that tried to force states to participate in the law’s expansion of Medicaid (which was one of the ways Obamacare was going to achieve near-universal health care coverage). The Affordable Care Act provided that, if states refused to go along with, and pay part of the cost of, the law’s expansion of Medicaid, they would lose the money they were already receiving for their current Medicaid program. In his opinion Chief Justice Roberts said that the federal government could withhold extra Medicaid money from states that did not agree to expand their Medicaid programs, but it couldn’t take away money they were currently getting.
Since the decision, some governors have indicated that they do not want to participate in the expansion of Medicaid because they do not think their states can afford it. Liberals are appalled. The New York Times worries that “substantial numbers of the very poor could be left out of [health care] coverage” if this happens. Jonathan Cohn at The New Republic argues it would be silly for states to not participate in the expansion:
“But state spending on Medicaid would grow less than 3 percent overall, according to the Congressional Budget Office. As the Center on Budget and Policy Priorities points out, the real cost to states would be even lower than that:
‘To assess the fiscal impact on states of the Medicaid expansion, one must look at more than just Medicaid, because the health reform law’s coverage expansions will reduce some state and local costs. As a result of health reform, Medicaid will essentially pay for many health services now provided to people who are uninsured. Thus, the federal government will bear a substantial share of the cost of providing health care services to people whose health care costs otherwise would be borne in part by state or local governments.’”
But if this Medicaid expansion is as important as The New York Times says, and if the cost is as little as Mr. Cohn says, why doesn’t President Obama just propose that the federal government pay for it? According to Mr. Cohn, the federal government is going to pay for most of the cost anyway, so why not pay for all of it? If it’s the federal government’s idea and the federal government’s law, why shouldn’t the federal government pay for it?*
It’s like President Obama’s idea to require health insurance plans to provide free contraception services to women. It became a big deal when the President tried to get religious-affiliated institutions to provide this coverage through their health insurance plans. Some people raised freedom of religion issues under the First Amendment. The Administration tried to solve the problem by saying that they wouldn’t make the religious-affiliated institution pay for the contraception coverage. They would make the insurance companies provide it for free.**
But if this coverage is so important for women’s health, why didn’t the Administration just say the federal government would pay for it. If the Administration tries to claim that the Republicans in the House would stop them, why didn’t they do it when Nancy Pelosi was Speaker? If it’s critical now, it was critical then. There wouldn’t be a First Amendment issue if the federal government was providing it. And if it is so inexpensive that insurance companies can do it for free, it shouldn’t’ cost the federal government that much to provide it.
It’s actually getting to be a trend with President Obama: He says he’ll provide the benefits, but he wants somebody to pay for them.
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* I assume that least part of the reason the President wanted the states to pay a share of the cost of expanding Medicaid was so that he could claim that Obamacare would not cost any money and would actually save money. If the federal government had to pay the total cost of the expansion of Medicaid, he couldn’t have made that claim.
** Sort of like how the Tooth Fairy pays for little kids’ teeth when they come out. It’s magic.
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