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The battle over Medicaid expansion

The battle over Medicaid expansion

This article originally appeared on heartland.org.

The political battles over Medicaid expansion are continuing across the country as states take up warmed-over versions of the so-called private expansion in Arkansas. What should opponents of these expansions be highlighting in their conversations about the Medicaid issue? The Foundation for Government Accountability has guidance in the form of a poll conducted in Virginia that outlines the messages that resonate with people:

When Virginia voters learn that ObamaCare’s Medicaid expansion slashes seniors’ Medicare, gives taxpayer-funded Medicaid coverage to former prison inmates and could deplete funding for critical state priorities, their support for ObamaCare’s Medicaid expansion plummets; this according to a new poll released today by the Foundation for Government Accountability (FGA), a multi-state free-market think tank based in Florida.

The 10-question poll was conducted between March 7 and March 9, 2014, with 469 likely Virginia voters responding to all 10 questions. Respondents were first asked whether they supported or opposed expanding Virginia’s Medicaid program to give taxpayer-funded Medicaid coverage to up to 400,000 more mostly working-age, able-bodied adults without children, with results showing a razor thin plurality, 42 percent, supporting expansion and 40.9 percent opposing expansion–well within the poll’s margin of error of 4.5 percent. When asked if they would be more or less likely to support expansion once they knew key facts about its impact, opposition only grew …

Medicaid expansion, now being debated in the Virginia Legislature, has resulted in dramatic attempts at political power plays. Newly-elected Virginia Governor Terry McAuliffe has threatened to shut down state government if the Legislature presents him with a budget proposal that does not include ObamaCare’s Medicaid expansion. That move, however, lacks support among Virginia voters. When asked about Mr. McAuliffe’s government shutdown threat, 56.5 percent of respondents expressed their opposition while just 29.6 percent indicated their support.

FGA also has a new video on the subject. The important thing to recognize is the persistence of the inaccurately described “private option” for expansion, which is already well on the way to dramatically increasing Arkansas’ tax burden:

ObamaCare advocates repeatedly promise that Medicaid expansion is fully funded by the federal government, at least through 2016. Advocates repeated this promise for the Arkansas “Private Option” Medicaid expansion, which sought to use Medicaid funding to deliver Medicaid benefits to a new class of working-age, able-bodied adults through private ObamaCare exchange plans.

But under terms of the Private Option federal waiver signed by Governor Beebe, state taxpayers could soon be on the hook for any cost overruns. The special terms and conditions of the Private Option waiver feature monthly per-person caps on federal spending for each of the next three years. A common feature of Medicaid waivers, these caps are meant to protect the federal taxpayer if the Private Option ends up being more expensive than previously estimated. Under the terms of the waiver, the state taxpayer is responsible for all costs which exceed these per-enrollee caps.

At the end of the waiver period, the federal government will calculate how much Arkansas spent on the Private Option Medicaid expansion and compare it to the annual budget caps agreed to in the waiver. Any amounts over those caps must then be repaid to the federal government from state tax dollars.

There is no justifiable case to be made for accepting the Obamacare Medicaid expansion at this juncture as a fiscal conservative. The funds will not end up in another state if you deny them; you will be putting able-bodied adults ahead of the disabled in the line for care; and the federal government will put your state taxpayers on the hook for more tax dollars. There is no such thing as free money, and the strings attached to this “free money” will be a problem for states for decades to come should these expansions go through.

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