Mr. Verma’s letter describes the fiscal benefits that would accrue from expanding Medicaid. While these perceptions are supported by the Perryman Group’s analysis, there are reasons for skepticism. First, illegal immigrants will remain ineligible for Medicaid under Obamacare, but they’ll still be able to seek medical care in hospital emergency rooms. This suggests indigent care costs may not drop very much. Secondly, although Obamacare obligates the federal government to pay at least 90 percent of the costs to treat new Medicaid enrollees through 2020, it’s unclear what will follow. It’s likely states will be asked to bear more costs.
My main objection to the notion that states are foolish if they don’t belly-up to the federal trough is that the trough is already empty. Our country is broke, largely because of its existing entitlement programs. We don’t need another entitlement. Obamacare’s goals may be noble, but the legislation is seriously flawed and will do more harm than good. We can do better.