Fallout continues from the Supreme Court decision on Obamacare and one aspect of the issue that will be debated for the next several months is how Medicaid expansion was affected and whether it can still work.
The original Affordable Care Act language ordered states to expand Medicaid to cover those families whose income is 133% above the poverty line — $23,300. That’s about 19 million more Americans that states will be responsible for covering. The government offered to pay up to 90% of the cost — but only for 4 years. After that, states are responsible for the additional money.
Realizing that many states might balk at expanding coverage, Washington threatened to withhold Medicaid grants from recalcitrant states if they refused the expanded coverage. It was this that the Roberts decision found unconstitutional.
So is expanded Medicaid coverage now optional for states? Yes and no, say experts. States can refuse to offer Medicaid to the expanded pool of insureds, but citizens would still be mandated to carry insurance. Ezra Klien explains:
[S]ubstantially more people than the law’s authors expected might find themselves eligible for either hardship waivers from the mandate or subsidies to buy insurance on exchanges. How much of each of those things happened will depend on exactly what states do, and figuring out the budgetary implications of the whole thing is going to require some hard work by the little modeling gnomes at the Congressional Budget Office.
So governors could refuse to offer expanded Medicaid coverage, but all they’d be doing is making Obamacare more expensive and unwieldy for the rest of us.
Then there’s the matter of the insurance exchanges. States are supposed to set up exchanges that will serve as a clearinghouse for the purchasing of health insurance in each state. They would also impose minimum regulations on the insurance being sold and provide a way for consumers to comparison-shop for insurance policies.
Governors could refuse to set up the exchanges but all that would do is force HHS to do the job. This would be an annoyance and again, make Obamacare more expensive for the rest of us. But it wouldn’t alter the basic program.
Nevertheless, GOP governors are vowing to do nothing to implement Obamacare at the state level until after the election.
Republican governors are planning to ignore the Supreme Court’s decision Thursday to uphold Obamacare hoping that the issue will drive voters to dump President Obama in favor of Mitt Romney who has vowed to kill the Affordable Care Act.
After the decision, the Republican Governors Association said that nothing should be done by the states until after the election, a clear signal that they believe a GOP president, House and Senate will kill the health care reform pushed through by Democrats and opposed by Republicans.
RGA Chairman Bob McDonnell said, “Today’s ruling crystallizes all that’s at stake in November’s election. The only way to stop Barack Obama’s budget-busting health care takeover is by electing a new president. Barack Obama’s health care takeover encapsulates his presidency: Obamacare increases taxes, grows the size of government and puts bureaucrats over patients while doing nothing to improve the economy.”
The Virginia governor, who is on Mitt Romney’s list of potential vice presidential candidates, added, “By replacing Barack Obama with Mitt Romney, we will not only stop the federal government’s healthcare takeover, but will also take a giant step towards a full economic recovery.”
Other governors have urged a similar strategy. Scott Walker, the newly re-elected Wisconsin governor, said that he won’t put into place any elements of Obamacare until after the election. Other governors are taking a similar position.
By taking the slow-down route, the Republican governors are hoping that the GOP sweeps in November and can somehow manage to get repeal through a less than veto proof senate. That’s a tall order, but it’s really the only option left.