Dr. Deane Waldman devotes a Washington Examiner column to the complicated issue of government-funded health care after the Affordable Care Act.
Suppose that the Trump administration makes good on its promise to repeal Obamacare. Suppose further that Dr. Tom Price, new secretary of the Department of Health and Human Services, decides to let the states decide how to provide healthcare to their residents.
The rationale behind turning healthcare over to the states is straightforward. (A) Based on the Constitution’s silence regarding healthcare and the Tenth Amendment, the states are responsible for the health of their people: Providing healthcare is not the federal government’s job. (B) Medicaid law clearly specifies that the programs are supposed to be “state administered” (quote from original 1965 law), not controlled by Washington.
If the states are responsible and in control, should the federal government give the states any federal dollars for healthcare? The answer is no and yes. …
… Because healthcare is not a federal responsibility, Washington does not need tax revenue to pay for it. Therefore, Washington should reduce federal taxation by the amount currently being spent on the healthcare system. Since Washington spends more than $3 trillion dollars per year, giving healthcare back to the states, in theory the federal government could reduce the federal tax burden of the average American by $9,375 per year (3 trillion divided by 320 million). …
… In 1986 Congress passed EMTALA. This law requires any hospital receiving federal support in any form to provide urgent or emergent care to a sick person regardless of whether the patient can pay, has insurance, or there is no source of payment at all for the hospital’s expenses. This is called the unfunded mandate. …
… It is only reasonable that if Washington passes a law that requires a large outlay of dollars by the states, Washington should pay that outlay. …
… The federal government should fund the unfunded mandate built into EMTALA. This means paying the states for the cost of federally mandated but uncompensated care. An alternative would be to repeal EMTALA and thus eliminate the unfunded mandate. This is a political nonstarter.
