An important aspect of last week’s Supreme Court on Obamacare is that the federal government can’t force states to expand Medicaid eligibility (by withdrawing all Medicaid funding, should states refuse). I have been asked several times whether Utah will expand its Medicaid coverage.
Background: Obamacare forces individuals to get healthcare or pay a tax. This was politically palatable for the Democrats who passed Obamacare, because most people weren’t going to have to pay for their healthcare; the Government (meaning other taxpayers) would pay for it. Part of the way the Democrats planned to have Government provide was to force states to expand Medicaid (poverty-level health insurance) to cover more individuals. With the Supreme Court’s ruling (upholding the mandate to buy insurance, but striking the Medicaid expansion provision), the working poor now will face a significant tax increase.
Discussion: Utah balances its budget every year. We have a triple-A bond rating. We are widely regarded as the best-managed state in the Nation. (Considering the competition, that might be like bragging about being the tallest building in Tooele, but, still, we do know a thing or two about budgeting and about fiscal responsibility.).
Utah has finite dollars. Medicaid already is the fastest growing part of the State’s budget, meaning that dollars are being taken away from all other areas of state government, such as education. In my 12 years in the Legislature, Medicaid has moved from commanding 10% of the budget to 20% of the budget. Do we want to expand Medicaid even more? No.
But, some might argue, the feds have agreed to pick up 90% of those costs. Remember, such promises aren’t worth the paper they’re written on. The federal government promises big Medicaid matches; the states expand coverage (because, with those matches, “it would be foolish not to!”); dependency develops for the expanded programs; the feds reduce/eliminate the match; states are left footing the entire bill.
And, if the federal government ever gets serious about balancing its budget (I know, I know), the first area the feds will look (where they’ll HAVE TO LOOK, if truly serious) is Medicaid.
So, will Utah expand Medicaid coverage to fix the tax problems created by Obamacare? No.