Dalrymple Backing Medicaid Expansion Is An Act Of Political Cowardice


Writing for the Washington Examiner, Shikha Dalmia tries to explain why Republican governors like North Dakota’s Jack Dalrymple are pushing for an expansion of Medicaid. Governor Dalrymple has referenced the “no cost” federal dollars which would fund the expansion (which forgets that we are all federal taxpayers too), but Dalmia suggests that it’s more than that.

Obamacare puts the states in a position where they can either put themselves on the hook for an unpayable expansion of health care entitlements in the long run or put their businesses at a competitive disadvantage in the short run. “Obamacare has states in a vise that they can only escape by going broke,” writes Dalmia:

Medicaid, the joint state-federal program for the poor, has been devouring state budgets for decades. Indeed, a December survey by the National Council of State Legislatures found that state budget experts overwhelmingly named Medicaid as their top budgetary challenge for 2013. This is no surprise, given that Medicaid is the single biggest item in virtually every state — ahead of transportation, K-12 and higher education. In the states, Medicaid consumes up to one of every four tax dollars. Some states, like Arizona, were so strapped that they started refusing organ transplants for poor patients until they got an infusion of stimulus dollars.

None of this, however, deterred Obamacare from requiring states to extend Medicaid to residents below 133 percent of the poverty limit — roughly 18 million additional people — or risk losing all federal funding.

States challenged this blackmail in the Supreme Court, and won. Yet now the conservative governors of North Dakota, New Mexico, Arizona, Nevada, Ohio and Michigan — some of whom were even party to the lawsuit — are voluntarily signing up for this provision. …

The reason is this: Under Obamacare, uninsured residents up to 400 percent of the poverty level will get subsidies from insurance exchanges set up by the states, or by Uncle Sam when states refuse. Employers will have to pay a $2,000 penalty for every uninsured employee who receives subsidies from the exchanges.

So extending Medicaid to cover these workers would protect employers — especially small businesses that don’t offer health insurance. Conversely, resisting Medicaid expansion would effectively impose an employment tax on small businesses with low-income workers. States that do this will be at a competitive disadvantage with states that do comply.

Dalmia is right, though I’d point out that this still doesn’t excuse jumping on board with the Medicaid expansion. Rather than talking about “no cost” funds from the federal government, political leaders like Dalrymple should actually lead on this issue. Point out the position Obamacare is putting the states in, and refuse to go along with it.

Sentencing future generations of North Dakotans, and Americans, to paying for unpayable levels of long-term entitlement commitments for a little short-term economic protection is a fool’s errand.

Politicians who take the easy way out, and leave the tough problems to future leaders, are cowards bereft of leadership.