Ending Medicaid Equally Nosotros Know It: The Court's Role

Perhaps the Senate's wellness attention mouth volition hold upward a political fizzle exactly if it passes, nosotros should at to the lowest degree seat the Supreme Court's purpose inward permitting Republicans to advance a proposal that would brand i of the biggest changes to the welfare terra firma always -- ending the purpose of Medicaid every bit an entitlement program.  As this WaPo story notes, amongst honor at to the lowest degree to Medicaid, the Senate mouth is consistent amongst an aim Republicans at the national degree accept had for years.  They accept wanted to cap federal Medicaid spending either through block grants or per capita limits.  As the floor says, the Bush 43 direction made a run at a block grant proposal.  But it doesn't tell why it didn't pass.

In the past, proposals to cap Medicaid unremarkably ran afoul of the nation's governors, together with on a bipartisan basis. Medicaid is jointly funded past times the terra firma together with federal governments.  Governors know what would hap if federal spending is capped -- they volition hold upward left belongings the handbag for a lot of real sick miserable people.  This is peculiarly the illustration during recessions when terra firma revenues pass upward sharply yet budgets must nevertheless hold upward balanced due to constitutional mandates.  In fact inward many past times recessions, including the Great Recession of 2008, states requested together with got additional coin from Congress to encompass the gaps that opened upward inward terra firma budgets for financing Medicaid.  Governors are sensitive to this number because they know they volition hold upward blamed for all the miserable people who can't larn medical attention when terra firma revenues decline.  And if the Senate mouth passes, that resultant is in all likelihood guaranteed inward the side past times side recession.

You mightiness figure that governors would oppose the Senate mouth together with roughly (including roughly Republicans) create oppose it.  But my feel is GOP governors inward detail are non speaking amongst i vocalisation this fourth dimension around.  They aren't because the Court created the option, unforeseen past times Congress, of non expanding Medicaid inward NFIB v. Sebelius.  If all states had expanded Medicaid, they all would hold upward inward the same set amongst honor to the Senate bill, which is a real bad one, every bit it rolls dorsum the expansion.  Parenthetically, I haven't seen much commentary on how the unlike parts of the ACA are intended to run together.  Reverse the Medicaid expansion together with to a greater extent than miserable people volition exhibit upward at emergency rooms, recreating the terms shifting occupation that the ACA tried to solve.  In whatever case, GOP governors inward non-expansion states seem to hold upward supporting the House together with Senate bills.  The unity that characterized governors inward the past times on Medicaid has been broken. For that, nosotros accept the Supreme Court to thank.