HHS Secretary Kathleen Sebelius reiterated today that a half-hearted or inconsequential expansion of Medicaid is unacceptable and that if states want to receive matching funds from the federal government, they must fully comply with the law.
Health and Human Services Secretary Kathleen Sebelius wrote a letter to governors saying the administration "continue[s] to encourage all states to fully expand their Medicaid programs."
In an accompanying blog post, she declared that "the law does not create an option for enhanced match for a partial or phased-in Medicaid expansion to 133 percent of poverty."
In other words, the states must take all or nothing. That sets up a dilemma for Republican governors, who have to decide whether to stonewall Obamacare or accept the generous funding to cover their low-income uninsured residents.
That last part is particularly important and it's what tells you that obstruction on the part of GOP governors is politically motivated.
States are not initially responsible for covering the the cost of expanding Medicaid. The federal government will reimburse the state for 100 percent of the expenses associated with the expansion of Medicaid for through 2016, after which the federal government will still cover 90 percent or more of the costs for the foreseeable future.
Take the state of Texas for example. Even though they're the second most populous state in the nation, even they will not have to pay a dime to expand Medicaid until 2017. In 2017 they will only have to pay for 5 percent of the cost. In 2020 and beyond, they will only have to pay for 10 percent of the cost. By 2020, other mechanisms of the law will have already lowered costs across the board. And yet Governor Rick Perry refuses.
This is essentially healthcare given to the state for free. All they have to do is extend their hand and accept the federal government's help. For their citizens' sake. This is money that has already been accounted for in budgetary projections. By not taking it, they aren't stickin' it to The Man and they aren't cutting costs.
It would be funny if it wasn't for the fact that their paranoid, partisan stubbornness will cost real people healthcare.
At some point, state refusal to fully get on board with Obamacare will translate into making states an unfavorable place to live and work. Perhaps at that point state legislators who are wary of being challenged for their offices will take matters into their own hands and comply with the law. But that's a big maybe.