Grandstanding Over Medicaid Begins in Florida, South Carolina

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Following Thursday’s Supreme Court decision, Republican governors in the South are starting to trip all over themselves to see who will be first across the line to turn down the Medicaid expansion that’s part of Obamacare. As it turns out, Florida’s Rick Scott and Louisiana’s Bobby Jindal took the checkered flag. Sarah Kliff assesses the damage:

The Affordable Care Act would have extended Medicaid to cover everyone who earns less than $14,500, regardless of whether they have children or not. That expansion, to cover higher earners, would have covered 951,622 Floridians, according to a Kaiser Family Foundation report.

In South Carolina, the expansion was expected to cover 330,932 people. Taken together, that’s 1.2 million people—about 7.5 percent of the 17 million people expected to gain Medicaid coverage—who would no longer have access to the program.

Needless to say, we should expect a lot more of this. I figure every Republican governor in the South, and at least half of them elsewhere, will do the same thing.

For now, though, I’m treating this as simply part of campaign season. It’s an easy way of ginning up the base, but it means nothing until 2014 rolls around and the Medicaid provisions of ACA actually kick in. I don’t doubt that some states will continue to hold out, but if Obama wins in November and ACA stays intact, I expect things to cool down over time. Some of the ideologues will stick to their guns, but not all of them. Eventually most will probably take the money.

Nevertheless, this is a good argument for one of my favorite policy prescriptions: we should federalize Medicaid. There’s never really been any good argument for making it a joint state-federal program, and there are plenty of good arguments for taking this monkey off the backs of state budgets and letting the federal government run the whole thing, just like they do with Medicare. Now, with the Supreme Court imposing new limits on federal authority to manage joint programs, we have yet another argument for federalizing it.

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