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One of the great things that Obamacare does (and there are many) is ensuring that more people are covered.  One of the ways it does that is through the extension of the Medicaid Program. Unless of course you're a conservative governor of Texas like Rick Perry.  To be fair, there are several Republican governors who are refusing to implement the program but Perry's state leads the nation in percentage of people uninsured.

I won't bore you too much with how Medicaid works but it's a joint program between the Federal government and the states to help cover their poorer residents.  The Federal government gives states broad guidelines but its the individual states that determine how the plan(s) are executed.  The average portion that the federal government pays is about 57% of the cost of the entire program.  But some states, like Texas, get 70.75% of those costs picked up.

So what does the Affordable Care Act do?  Well it enhances eligibility from 100% of the poverty line to 133%.  That is quite literally millions of people who don't have access to care being able to get it.  Especially in a state like Texas, which has the highest population of uninsured people in the nation at 27.8%.  Now here's the best part, the ACA doesn't just force governors to cover a bunch of new people without extra money coming their way.

For the first three years of the program 2014-2016, the federal government will pick up 100% of the additional costs of the Medicaid expansion.  Then it will slowly decrease to a floor of 90% by the year 2022.  That is an absurdly good deal for the states.  But who cares if it its a program that will help people?  Who cares if the OVERWHELMING majority of the program is paid for?  If you're a Republican ideologue, freedom from Federal government intrusion is much more important.  Unless of course, you need to balance your budget with stimulus money or the aforementioned 70.75% of the Medicaid budget you already take every year.

Here's the thing that people either don't understand or are unwilling to: everyone pays for the uninsured.  We pay with extra-long waits in the emergency room because that's where people without insurance go as a substitute for primary care.  We pay in higher premiums because uncompensated hospitals visits from the uninsured end up getting charged to insured patients.  In fact, according to the Texas Medical Association:

Taxpayers, Texans with insurance, and employers who offer health benefits also pay extra for caring for the uninsured. Families USA estimated the total cost for Texas in 2005 to be more than $9.2 billion. Of that:

The patients and their families pay about half ($4.6 billion);
Government health programs pay one-sixth ($1.6 billion); and
Those with private health insurance subsidize the remaining third ($3 billion).

So there are no escapes from these costs.  The only difference is proceeding the Texas way is inefficient, expensive, and drives up the costs for the rest of the insured population by way of taxes and premiums.  The best argument for the expansion of Medicaid is an economic one.  We can pay these costs upfront when it's a lot cheaper, give people access to actual primary care, and slow down the exploding rise of health care premiums.  You'd think a true fiscal conservative would understand and even appreciate that very simple math.

Then again, he's not a true fiscal conservative.  This is a person that bemoaned all of the useless federal spending in the stimulus bill but then promptly used stimulus funds to balance the Texas budget.  This is person who bristles at the thought of supposed government overreach but gleefully takes more than two-thirds of the cost of his own state's Medicaid program.  And every so often, Perry likes to talk about Texas seceding from the United States.  I seem to remember that not going so well for the South.  But hey, roll the dice and see how that works out for you.

True conservative?  Only in his dreams.  True hypocrite seems a much more apt moniker.

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