One of the Pyrrhic victories to come out of the Supreme Court’s Obamacare ruling was that the federal government could not withhold all of a state’s Medicaid monies if it refused to expand the program. Some Republican governors, like Rick Perry of Texas and Florida’s Rick Scott, have declared that they will not expand their state’s programs. Not surprisingly, this has lead the usual suspects to cluck and thunder that such refusals are tantamount to tossing indigent grandmothers to the wolves.
Governor Bob McDonnell, though, is not yet among those who have spurned the fed’s wishes and cash. He’s filled with uncertainty, because the feds haven’t detailed how the larger program will work, who will pay for what, and for how long. In his capacity as chairman of the Republican Governors Association, McDonnell posed a litany of questions to the Obama administration on these points.
But the heart of the matter is much simpler: how on earth can the feds hope to pay for the commitments they want the states to make? On that issue, McDonnell’s letter states:
We also do not understand how the federal government can begin to afford to implement PPACA, with deficits already over $1 trillion in every year of your presidency, and the debt growing $5 trillion in the past 3 years to an outrageous record of nearly $16 trillion.
The answer is it can’t be paid for. Not now, next year or in the mythical budget years to come because the federal government is broke.
No amount of clarity from the White House on the Medicaid program, the health insurance exchanges or any other facet of Obamacare can change that.
And what of the cost to Virginia if we ignore this and decide to go ahead and expand Medicaid?
Mr. McDonnell characterized the growth of Medicaid in the state’s budget as “an unsustainable trajectory that demands improvement and greater efficiency.” Medicaid spending has grown 1,600 percent over the past three decades, and the program now comprises about one-fifth of the state budget.
A 2010 estimate showed that the Medicaid expansion would cost Virginia $2.2 billion starting in 2014, but Mr. McDonnell wrote that the Department of Medical Assistance Services is currently updating that projection.
Virginia could cover that cost if we were to decide to take the money from elsewhere in the budget. Or raise taxes. Or both. Good luck with that.
Yes, all of this is a rear-guard political action against the law, pinned to and supported by a belief that if November’s elections turn out right, then the new GOP majority and President Romney will ride to the rescue. We shall see.
If those hopes are dashed, though, the foot-draggers will be forced to choose. Here’s hoping that no matter what the outcome in November, they refuse to grow the already teetering-toward-insolvency Medicaid program. There’s simply no money in the till, the couch cushions or the bond market to cover it.
