A Coercive Expansion of Medicaid?
The Wall Street Journal this morning reported on studies by various state legislatures about the feasibility of dropping their Medicaid programs. Much of the information has been previously reported in earlier articles; however, the Journal piece did include one key paragraph with significant implications:
A quirk in the law passed in March suggests that a portion of the new Medicaid enrollees could instead qualify to get a tax credit to buy private insurance on state-run exchanges, although Democrats say that wasn’t the intent of the law.
In other words, Democrats claim it “wasn’t the intent of the law” to allow low-income individuals to obtain subsidies to purchase health insurance if their state drops out of Medicaid. Does that mean that Democrats intended to leave low-income individuals – including those with incomes below the poverty level – without coverage if their state drops out of Medicaid? Or does that mean that Democrats effectively commandeered state governments, by indicating that low-income individuals could ONLY obtain subsidized insurance coverage if states incurred additional costs by expanding their Medicaid programs?
The Administration has yet to weigh in on this issue with an official ruling, perhaps because of the fiscal – and legal – questions it raises. If the Administration allows low-income individuals to obtain subsidies if their states drop out of Medicaid, states will have a financial incentive to do just that. If however the Administration prohibits such individuals from obtaining subsidies, it will become patently obvious that Democrats intended to expand insurance coverage – the health care law’s top goal – by forcing financially strapped states to expand their Medicaid programs, raising further constitutional questions about a law already subject to multiple legal challenges.