10.31.2013 0

Will Obama force states to expand Medicaid (without them knowing it)?

Wall_Against_TyrannyBy Robert Romano

One of the parts of the Supreme Court ruling by Chief Justice John Roberts that upheld Obamacare last year made Medicaid expansion by states optional. As result, only 21 states have decided to participate in the program’s massive expansion.

How massive?

According to Medicaid.gov, “Beginning in January 2014, individuals under 65 years of age with income below 133 percent of the federal poverty level (FPL) will be eligible for Medicaid. For the first time, low-income adults without children will be guaranteed coverage through Medicaid in every state without need for a waiver, and parents of children will be eligible at a uniform income level across all states.”

Currently under Medicaid, applicants need to be either low-income children, pregnant women, the elderly, individuals with disabilities, and parents meeting specific income thresholds to qualify. Now, if states choose to expand, everyone without a job or below 133 percent of the poverty level will qualify.

The Kaiser Family Foundation had previously estimated that up to 23 million people would qualify for the expansion nationwide, but with only 21 states that have done so (or implemented an alternate expansion), the administration is nowhere near that goal.

The other 29 states, including Ohio, whose arbitrary expansion by Republican Gov. John Kasich is under legal challenge, have 13.8 million who would have qualified for Medicaid expansion, but will not since the states have not expanded.

But what if the Obama administration decided to enroll them anyway without the states knowing?

Because the federal government will be covering 100 percent of the costs of the expansion until 2017, when it drops to 95 percent, states would at least be financially unaware the Medicaid rolls were being expanded right under their noses. By 2020, federal subsidies for the Medicaid expansion to 90 percent.

By the time the states figured out what was happening, it would be too late.

The additional expansion would be at a total cost of $68.6 billion, including a $6.8 billion eventual, annual liability for the states.

Because many of these same states opted not to create state-run exchanges to purchase insurance under the law, the federal government is handling those applicants. They might not know if the administration was adding ineligible Medicaid enrollees — it will be the federal government determining eligibility.

So, will Obama do it? One clue may come from Demos.org, which is noting that Medicaid applicants are being near-automatically registered to vote on Healthcare.gov under the National Voter Registration Act of 1993.

This could create all of the incentive the White House needs to simply ignore the Roberts ruling and go ahead and enroll Medicaid ineligibles in non-expansion states. Even if courts eventually struck down the Medicaid expansion, there would still be the millions of new, low-income registered voters, mostly in red states. Or, even if the administration does not want to enroll ineligible Medicaid recipients, perhaps the goal is to simply get them on the voter rolls.

That would be worth its weight in gold for Democrats, since those new voters could help tip the balance of power in those states.

The question is why is the Department of Health and Human Services registering people to vote?

There are those who have argued that this was the intended purpose of Obamacare all along — to flip the political balance of power in red states by creating a new constituency of government dependents.

Which is why state officials need to be vigilant in ensuring that the administration is following the letter of the law as stated by the Supreme Court. This could be a Trojan Horse.

Robert Romano is the senior editor of Americans for Limited Government.

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