How Do We Pay For It?

ObamaCare Can Break Va.

Posted: February 12, 2013

Some issues simply get stuck in your craw — and, for us this week, that issue has been Medicaid expansion under ObamaCare.

On Monday, for example, we took John Kasich, Ohio’s Republican governor, to task for a reversal of field that will, more than likely, result in his state taking the short money — i.e., full federal funding of said expansion for the first three years of ObamaCare. Lately, we’ve learned Mr. Kasich is hardly alone among formerly intransigent Republican governors in this regard.

GOP counterparts in North Dakota, Nevada, and New Mexico have already signed on, as has Midwest colleague Rick Snyder in Michigan. Down South, Florida’s Rick Scott is said to be wavering and, in Texas, GOP lawmakers, it’s been reported, are quietly seeking ways to overcome Gov. Rick Perry’s resistance.

But the week’s biggest news came from Arizona, where feisty Gov. Jan Brewer signaled an intent to expand the program. Fellow Republicans in the legislature may balk at this proposal.

All this was sufficient for us to ask “Why?” Each state may offer different rationales, but, in a macro sense, certain reasons appear universal. Misguided and myopic, perhaps, but universal.

It all starts with the allure of that short money. For example, Arizona, so notes The Urban Institute, will shell out $3.1 billion over 10 years for Medicaid expansion but will receive $17.3 billion from the feds for its participation.

Another factor weighing heavily in such decisions has been the support of state medical communities — hospitals, especially — for the expansion. The ObamaCare law reduces federal aid to hospitals for providing uncompensated care. As such, states that don’t expand will compel hospitals to treat larger pools of uninsured patients even as payments for doing so fall. We hear this argument being made in Virginia, where the viability of rural hospitals will be threatened should expansion not occur.

Ah, Virginia. What is happening here? The Senate and House of Delegates are meandering toward possible expansion via different timetables.

In its version of the budget, the Senate crafts provisions — e.g., a Medicaid reserve fund — that could initiate expansion as early as Jan. 1. The more conservative House passed a budget requiring 1) reform of Medicaid en toto and 2) approval of this reform by the Assembly in 2014 before expansion can take place. These versions must be reconciled. Neither body has appropriated money for an expansion.

Sen. Jill Vogel, R-Upperville, rightly declared that the state — particularly its conservative lawmakers — are in a “bind.” Many of her colleagues “despise” ObamaCare, yet believe Virginia will “lose billions if we don’t step up.” Hence, an “urgency” to “do it our way, with our reforms” — if for no other reason than to preserve those needed hospitals in rural areas. Still, there’s always the fear that no matter when Virginia pulls the trigger on expansion, Washington can leave the states “holding the bag in the long, long term.”

“Either way, health care can break us,” Mrs. Vogel warned.

Hence, our concern about mitigating short-term risk knowing full well the feds may not, or will not, hold up their end of the bargain. Talk about flirting with disaster.

Or, as House Majority Leader Kirk Cox, R-Colonial Heights, says, “How on earth is [this] going to happen with a federal government that’s not only broke, but totally broke?”


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