One provision of health reform which has the states up in arms, for varying reasons, relates to the expansion of Medicaid coverage. First, the expansion creates a mandate by the federal government levied upon the states, since Medicaid is basically a 50/50 matching program of state and federal dollars. Second, some states, which have expanded benefits for Medicaid beneficiaries, enacted on their own and at their own expense, are nonplussed that states with more basic benefits will get federal dollars to expand their Medicaid coverage. Third, the proposed expansion of eligibility for Medicaid, up to 150% of the federal poverty level in House version, and 133% in the Senate version, will create the largest unfunded mandate placed on the states by the federal government in history. It would be well for all to remember the Constitution of the United States. The 10th amendment to the Constitution, part of the original bill of rights states clearly: The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people. Many states are already deeply in the red in terms of their budgets and cannot figure out how they will raise revenues to meet this federal demand. Of course, states, like the federal government do NOT produce revenue, but consume it. Therefore it is logical to believe that at the state level, taxes and fees will have to increase to cover the costs of Medicaid expansion. Since the Federal treasury is also deeply in the red, federal taxes, fees and the like will surely need to be increased to meet this demand. Tax and fee increases of the magnitude that will be needed, in the midst of a weak economy, will no doubt have a chilling effect on economic recovery and growth. This will add to the national deficit, increase borrowing, increase the percentage of GDP that goes to pay debt interest and service, weaken the dollar further and propel us toward a dangerous hyperinflation, or worse, a deflation. Most health care issues could have been dealt with in a manner that would have accomplished many of the genuine goals sought, without this massive expansion of federal power, spending and debt . . . obi jo
Health Care Nullification Legislation – http://www.tenthamendmentcenter.com/nullification/health-care/
Arizona HCR2014: National Health Care Nullification – http://www.tenthamendmentcenter.com/2009/06/26/arizona-hcr2014-national-health-care-nullification/
States that have already broadly expanded health care coverage are pushing back against the Senate overhaul bill, arguing that it unfairly penalizes them in favor of states that have done little or nothing to extend benefits to the uninsured. With tax revenues down and budgets breaking, the states — including Arizona, California, New Jersey, New York and Wisconsin — say they cannot afford to essentially subsidize other states’ expansion of health care. The bill passed by the Senate on Thursday would move toward universal health insurance coverage in large part by expanding Medicaid, a program whose costs have traditionally been shared by the states and the federal government. Massachusetts and Vermont, the states providing the broadest coverage, have already received some relief for the anticipated Medicaid costs in the negotiations that led to the passage of the Senate bill. To secure the crucial 60th vote from Senator Ben Nelson, Democrat of Nebraska, Senate leaders permanently exempted his state from paying to expand Medicaid. But other states, many of them strong supporters of an overhaul, have been left in the lurch.
South Carolina Attorney General Henry McMaster on Monday stressed that Senate Democrats’ move to cover Nebraska’s new Medicaid patients in full could represent “corruption.” In an interview McMaster said Democrats included the provision in the chamber’s healthcare bill purely to buy Sen. Ben Nelson’s (D-Neb.) much-needed vote. It is ultimately unconstitutional, McMaster added, as it places a disproportionate burden on the 49 other states to cover Nebraska’s Medicaid costs.
States With Expanded Health Coverage Fight Bill – http://www.nytimes.com/2009/12/27/health/policy/27states.html?emc=tnt&tntemail0=y
States Fight Medicaid Expansion – http://online.wsj.com/article/SB124571731912339159.html
Payoffs for states get Harry Reid to 60 votes – http://www.politico.com/news/stories/1209/30815.html
S.C. attorney general: Medicaid deal could ‘represent corruption’ – http://thehill.com/blogs/blog-briefing-room/news/73747-sc-attorney-general-medicaid-deal-could-represent-corruption
Big payoffs to senators on health bill stoke public anger – http://www.washingtonexaminer.com/politics/Big-payoffs-to-senators-on-health-bill-stokes-public-anger-8675288-79940092.html
Getting ‘reform’ the wrong way – http://www.messengernews.net/page/content.detail/id/521209.html
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There’s another ramification to expanding Medicaid. Physicians do not welcome these patients into their practices because the reiumbursment is so pitiful. It makes Medicare seem like a high roller by comparison. If physicians are turning away higher paying Medicare, what do you expect they will do with Medicaid? Personally, I see these patients and I like them. But, our practice has overhead and expenses like any business. http://www.MDWhistleblower.blogspot.com
Agree fully. The next focus in our debate needs to be on manpower issues and payment. Not enough docs to handle this and Medicaid is so low paying that most doctors either do not see Medicaid at all, or limit acceptance to referrals only (no walk ins). Your points are on target. Thanks for the comment.