by Mitch Kokai
Senior Political Analyst, John Locke Foundation
North Carolina is not mentioned in the article, but you can bet top Tar Heel officials are paying attention to the shenanigans described in this Bloomberg Businessweek account of recent political developments surrounding Medicaid expansion.
In 2012, the Supreme Court ruled that the federal government couldn’t force states to expand eligibility for their Medicaid programs under the Affordable Care Act. Since then, the Obama administration has looked for ways to persuade Republicans who have steadfastly opposed Obamacare to participate in this key component of the act. The biggest incentive is the law’s promise of federal funds to cover the whole cost of newly qualified Medicaid patients for three years, until 2016, and at least 90 percent of the costs thereafter. Nevertheless, 20 states have refused to ease access to their Medicaid rolls. A few have been able to eat their cake and have it, too: Because of special arrangements that predate Obamacare, four states that haven’t expanded Medicaid have been getting billions each year in extra funding to pay for the care of people who are uninsured.
That’s about to change. On April 14, the Centers for Medicare and Medicaid Services (CMS), which manages federal funding to the states for health programs, alerted Florida officials that CMS plans to let the $1.3 billion the state gets annually to help hospitals cover the cost of treating uninsured patients lapse at the end of June. “Uncompensated care pool funding should not pay for costs that would be covered in a Medicaid expansion,” CMS wrote in its letter, which it released to reporters.
Rick Scott, Florida’s Republican governor, responded two days later with a threat to sue the Obama administration. “It is appalling that President Obama would cut off federal health-care dollars to Florida in an effort to force our state further into Obamacare,” Scott said in a public statement. On Fox News, Scott was more animated: “This is The Sopranos. They’re using bullying tactics to attack our state.” Scott’s office declined to comment further.
Texas Governor Greg Abbott quickly joined forces with Scott. Texas’ special Medicaid funding, which accounts for about half of the state’s $3.4 billion pool to repay hospitals for treating uninsured patients, expires in September 2016. In an April 20 statement, Abbott, a former attorney general who took office in January, vowed to support Florida’s suit. (As of April 22, no lawsuit had been filed.) “The Supreme Court made it very clear that the Constitution does not allow the federal government to use these coercive tactics against the States,” Abbott said.
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