One component of President Obama’s health care law that faces a very steep, uphill trudge is the expansion of Medicaid to 133 percent of the poverty line. While it is imperative that states buy into the expansion, tight budgets in nearly every state will result in some difficult choices.
Consider this comment from Gov. Dave Heineman of Nebraska, Republican, chairman of the National Governors Association:
“As I have said repeatedly, if this unfunded Medicaid expansion is implemented, state aid to education and funding for the University of Nebraska will be cut or taxes will be increased,” Mr. Heineman said.
This is not just political posturing. If expansion costs $3 billion in a state, at some point that state is going to have to come up with $300 million down the road to pay for it. With balance budget requirements, the money has to come from somewhere. To make that happen in New Jersey, where the state is required to balance its budget, it would require either cuts in spending or a tax increase. The extra costs cannot just be added to the budget without some give elsewhere.
I still think expansion is necessary to aid low-income people. But it offers another example of the flaws in the Affordable Care Act and the need to continue fighting to create a more just and egalitarian health system — i.e., Medicare-for-All/single-payer at least as an alternative to the private market — that does not impinge on state budgets or rely on an essentially corrupt private insurance market that privileges profit over care and sets as its primary goal the denial of service to keep costs low.
Hank Kalet 