Gov. Rick Scott (R-FL)
In light of the
ongoing debacle in Florida over Gov. Rick Scott's refusal to take federal money that has Obamacare cooties, Politico takes a
deep dive into Medicaid expansion and its consequences so far. The big takeaway: enrollments are far exceeding expectations, leading Republican governors to say "I told you so," and feel very smug that they are refusing to help tens of thousands of their citizens.
The federal government is picking up 100 percent of the expansion costs through 2016, and then will gradually cut back to 90 percent. But some conservatives say the costs that will fall on the states are just too big a burden, and they see vindication in the signup numbers, proof that costs will be more than projected as they have warned all along.
That's Scott's argument, more or less, that and what if the federal government decides to end the program (though it's never, ever backed out of a Medicaid agreement with a state). There are plenty of examples of states that took the expansion that have far more enrollments than expected: Illinois estimated 199,000 enrollment and got nearly 634,000; Washington estimated 190,365 by March of this year, got 535,000; Michigan projected 323,000 and currently has 582,000. Which brings up one key question: why are they so bad at these estimates? Do the states really have such a poor grasp on the economic status of their own populations? Do they imagine that no one is going to show up if they start publicizing the program?
The argument for Republicans is that this is just going to cost a ton of money that they hadn't counted on. For a detailed look at this, read Charles Gaba. But the gist of it is this: there are a lot of people who qualify for traditional Medicaid—which doesn't have the current 100 percent federal assist—who discovered they were eligible and signed up as a result of publicity around the launch of Obamacare's program. The states are paying more for those people and don't want to take on even more in two years when the federal contribution drops to 97 percent for people covered under the expansion. The argue that these people will cost a lot more and they won't be able to get into see a doctor anyway since doctors don't take Medicaid patients. Yes, there is a breakdown in logic there—if they aren't getting care, how could they cost more? At any rate, it's just all going to cost so much money and why do we want to help the moochers Republicans say.
Which leads to the counterargument, not just that states "and hospitals and doctors—are getting billions of dollars from the federal government to cover low-income people, letting them save money on other programs that had been fully or partly funded through state dollars." As Audrey Haynes, secretary of Kentucky’s Cabinet for Health and Family Services, which did take the expansion under Democratic Gov. Steve Beshear, says "can we afford not to take this?" Economically, there aren't a lot of good reasons for refusing the expansion. Morally, there are none.