CATO Institute: Ilya Shapiro: ObamaCare's Medicaid Expansion Violates Federalism

Source:FreeState Now 

I would’ve gone farther to bring down healthcare costs with things like preventive care, taxing junk food and drink, getting junk food and drink out of public schools, encouraging people to eat healthy and exercise, mandatory physical education K-12 and other things. And I certainly didn’t like the Medicaid expansion that was in the ACA that wasn’t paid for. And thats what I”m going to blog about.

Medicaid was set up in 1965 as part of the LBJ Great Society. To provide Health Insurance for low-income people who can’t afford it, sounds noble enough right. And that the Federal along with state governments would provide the funds to pay for it, another Federal mandate on the states. One problem with Medicaid has been the Feds haven’t lived up to their share of the costs of Medicaid that they wrote in their own law and as the cost of health care in America has gone up. 

Health care costs have gone up since Medicaid was created in 1965, so has the States Medicaid costs. But the Federal Government, has not only not paid for their share of what they originally said they would pay for, but of course they haven’t been providing the funds to pay for the new Medicaid costs that the states have picked up as well. Which have been made worse the last ten years with state revenue shrinking with a couple of recessions and everything else.

What I would like to do with Medicaid is take it off both the Federal and state budgets. Allow each State to have their own Medicaid as well as healthcare system. And then turn Medicaid into a semi-private non-profit health insurer. With each State having their own version of Medicaid. And make Medicaid self-financed as well by their customers and employers, Unemployed workers would get an additional tax credit to go along with their public assistance check to cover their Medicaid insurance. 

low-income workers would pay for part of their Medicaid insurance. And their employer would cover the other part. And both the workers and employers would be eligible for a tax credit to cover that. And you could pay for that out of corporate welfare. As well as workers and employers could use that tax credit and opt out of Medicaid for private health insurance.

I got this rule that I like to use in life, before you create a new mess, clean up your first mess. Which is how I would describe Medicaid. Its a Financial Mess, that no one wants to pay for. Because the money isn’t there, it has to come out of general revenue. And takes money out of other priorities. So before you expand something like that, you should first fix it.