They still haven’t read ACA
Via NRO
States continue to consider whether or not to expand Medicaid under Obamacare, and some are trying to shut the door on it — tightly. The Kansas legislature, for instance, has indefinitely barred the governor from expanding Medicaid; it’ll take the legislature affirmatively voting for the expansion at some point to reverse this.
But its next-door neighbor, the state Missouri, seems to be heading in another direction. Governor Jay Nixon argues that not expanding Medicaid means the state is losing millions of dollars – as in, by not increasing the number of Medicaid recipients, which will cost the state money, the state is losing out. Yes, at first the federal government will cover 100 percent of the cost of the expansion (though the state would still have to foot the bill for administrative costs). But after three years, the federal government will reduce its subsidy to 90 percent of costs — assuming it keeps its commitment over time in the face of its own financial problems. Some Missouri politicians are so convinced this actually involves spending less that Republican state senator Ryan Silvey proposed a “Missouri Solution” that explains what to do with the money “saved” by the expansion.
I have bad news for the state politicians thinking like Silvey: First, there are no free lunches. The money for the Medicaid expansion comes with strings attached — mandates and rules dictating how the states should spend their money, what services they should provide, and how they should provide them.
State officials should know that already, because that’s pretty always how the federal government operates. In a 2012 article from Governing, George Mason University professor Paul Posner explains that “there are more than 950 federal grants that provide the vehicle for most federal mandates, rules and regulations affecting the states.” In fact, he explains, “They . . . are the principal constitutional vehicle that allows Congress to adopt policies beyond its enumerated powers in such areas as education, law enforcement, community development and social services.”