Experts disagree on whether states will choose to expand Medicaid

Experts disagree on whether states will choose to expand Medicaid, a crucial, but voluntary, part of the federal health-care reform law. Yesterday, the Supreme Court ruled the federal government could not force states to expand the system for the poor and disabled, but that the expansion itself is constitutional.

Yesterday, both Gov. Steve Beshear and Senate President David Williams both indicated they are researching how Kentucky should proceed.

U.S. Sen. Lamar Alexander, R-Tenn., said "many states, maybe most, will decide that they simply cannot afford to choose to expand Medicaid." Though the federal government will pay for the newly eligible enrollees for several years after the law takes effect in 2014, states will eventually have to pay 10 percent of the cost.

Despite the expected cost, Sara Rosenbaum, a professor of health law and policy at George Washington University, predicts that "only a small number of states" will pass up the opportunity to expand, given the federal government's generous offer, reports Robert Pear for The New York Times.

The Medicaid expansion is central to the health care law, since about 17 million of the 30 million Americans who will newly qualify for health insurance will do so under Medicaid. In Kentucky, that translates to 280,000 more people enrolling in the program.

Senior administration officials said they feel sure states will choose to expand Medicaid, but Republican governors like Mitch Daniels in Indiana and Bob McDonnell in Virginia would not commit either way. Daniels said the expansion would cost Indiana $2 billion in the next 10 years.

And though U.S. Sen. Max Baucus, D-Mont., is one of the authors of the new law, he was not sure his own state would opt to expand. He did call the offer of federal assistance "a big juicy carrot." (Read more)