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The White House's top health official made clear on Monday that it would not fund a partial Medicaid expansion for states that choose not to embrace the new funding under the Affordable Care Act.
Health and Human Services Secretary Kathleen Sebelius wrote a letter to governors saying the administration "continue[s] to encourage all states to fully expand their Medicaid programs."
In an accompanying blog post, she declared that "the law does not create an option for enhanced match for a partial or phased-in Medicaid expansion to 133 percent of poverty."
In other words, the states must take all or nothing. That sets up a dilemma for Republican governors, who have to decide whether to stonewall Obamacare or accept the generous funding to cover their low-income uninsured residents.
I don't have much to add, but that the Obama administration continues to surprise me with its ability to cleverly negotiate its opposition into a tough situation. Remember that the ruling for the Medicaid expansion was the only silver lining for the Republicans by the SC decision. Now Obama is taking that away too.
There is no way that the Republican Governors will reduce Medicaid coverage to patients already on the rolls. They will have no choice but to expand coverage as the Administration requests. Brilliant stuff.
Just to clarify my point, think about Republican posturing on Obamacare. They know as long as the benefits do not yet come in for Obamacare, they have a shot at removing it, or demagoguing it. But once the benefits start coming in, it's too late to remove it. That's why they tried so hard to get rid of it. Once it's in place, it is difficult to remove.
Same thing with Medicaid. Stopping rolls from expanding is easy. But removing people ALREADY on rolls is difficult, because it affects real people, and creates outrage. Once the poor whites of that state, who are content on demagoguing the issue, start losing their benefits, they will realize the game being played and there will be outrage. Can Governors do it? Well, yes they can. But, they will face poll numbers similar to Bush. Most will not make that decision. Im confident.