Counter Point, by Patrick Werner Executive Director
Missourians for Prosperity
The Right to say NO!
On June 28th, 2012 The Supreme Court ruled that the President’s health care law unconstitutionally tried to force states to expand their Medicaid programs and as a result delivered a victory to supporters of limited government and principled federalism. For the first time in modern American history, the Court ruled that there is a limit to Congress’s power in compelling state action. Now each state must decide whether to implement this failed expansion or not.
Under the President’s health care law, Medicaid eligibility would vastly expand to all individuals below 133% of the federal poverty level—approximately $30,000 for a family of four. An estimated 17 million people will join Medicaid starting in 2014.
What should a state do? The answer is quite simple: States should refuse to expand their Medicaid population.
First, instead of expanding a broken system, states should instead join together and force the federal government to reform. States already hate the current Medicaid system due to the numerous regulations and red-tape from Washington, D.C. States basically function as de-facto administrators of the federal government’s failed health care policies. Just last year, legislators in Washington State and Texas, two states on opposite ends of the political spectrum, moved to free themselves from 
Washington, D.C.’s stranglehold. States have a choice and should exercise it. As Chief Justice Roberts wrote in one portion of the decision: “The States are separate and independent sovereigns. Sometimes they have to act like it.”
Second, states can’t afford the Medicaid expansion. From 2014 to 2019, conservative estimates put the states’ cost of expansion at $21 billion. While the federal government is currently scheduled to pick up the costs for the first several years, states will be stuck paying an ever increasing share of the cost up to 10% in 2020. But as the federal government continues down the path of increased spending and unsustainable debt, there is no guarantee that future congresses won’t ask the states to pay more of their “fair share” in the future?
Finally, states must remember that Medicaid is a broken health care system. Its provider payments are already too low causing poor health outcomes. A recent study found that uninsured individuals have better health outcomes than Medicaid recipients. In fact, more than 28% of doctors surveyed refuse to accept new Medicaid patients. Why would states want to force individuals into a failed health care system?
An ever increasing number of states have already said no and will not participate in this unworkable structure. The Supreme Court gave States a say for the first time. It is up to them to decide whether or not they want to expand their Medicaid program. States should unite together demand reform and tell the federal government no to a broken and costly system.
