Medicaid has a price, too

This image shows the website for updated HealthCare,gov, a federal government website managed by the U.S. Centers for Medicare & Medicaid Service. (AP Photo)

As enlightening economist Milton Friedman warned, “There’s no such thing as a free lunch.” But some folks believe there’s such a thing as “free” Medicaid expansion.

No, there isn’t.

Under the misnamed Affordable Care Act, the federal government covers the entire added cost of raising eligibility from 100 percent to 138 percent of poverty-level income for three years. Then a state’s share of that extra expense rises in increments to a maximum of 10 percent.

Participation in the Medicaid expansion was mandatory in that massive health care overhaul passed by Congress without a single Republican vote and signed into law by President Barack Obama in 2010.

But while the U.S. Supreme Court upheld the ACA in 2012, its ruling also scrapped that mandatory expansion by all states as unconstitutional. Instead, the justices made the change optional for each state.

South Carolina is among the 21 states that haven’t chosen to expand Medicaid. And Florida, which also has rejected that alternative, is suing the administration for attaching expensive strings to that decision.

To borrow from a memorable line in “The Godfather,” has the White House tried to make the Sunshine State an offer that it can’t refuse?

That’s the charge from Florida Gov. Rick Scott, who last month announced that his state was suing the U.S. Department of Health and Human Services over what he called its attempt to “cut off federal health-care dollars to Florida in an effort to force our state further into Obamacare.”

As reported by The Hill:

“At issue is the Obama administration’s move to link Florida’s rejection of the Medicaid expansion to separate federal funding that helps hospitals care for the uninsured.”

The White House hasn’t been as heavy-handed in its efforts to bring other states into the more-Medicaid fold — yet. Indeed, it’s even made state-specific concessions to win some of them over.

For instance, Indiana signed up early this year after it got a waiver allowing it to charge premiums for Medicaid coverage. And on April 29, Montana Gov. Steve Bullock signed a bill with similar stipulations, including turning the state’s Medicaid management over to a private insurer.

So why shouldn’t South Carolina expand Medicaid, too?

Again, because there’s no such thing as “free” health care — and because while a state’s eventual 10 percent might not sound like much, even if the share stays that low (don’t count on it), that would still rise to a considerable expense in an expanded program.

As for overwrought charges that it’s “immoral” not to vastly expand Medicaid, ponder Medicare’s financial prognosis. Barring costly and apparently politically untenable reforms, it’s bound for a disaster with consequences far beyond that unsustainable entitlement behemoth.

So with our national debt already $18.2 trillion and on track to steeply rise over the next decade, what’s so moral about making more phony promises about “free” health care?

It’s true that under the ACA more Americans have gotten health insurance. Yet it’s also true that the allegedly “free” Medicaid expansion has driven that gain.

Meanwhile, The Washington Post reported on May 2:

“Almost half the state health exchanges set up through Obamacare are struggling over their future, despite receiving billions of dollars in federal aid to gain their footing.”

And from last Monday’s Wall Street Journal: “Emergency-room visits continued to climb in the second year [2014] of the Affordable Care Act, contradicting the law’s supporters who had predicted a decline in traffic as more people gained access to doctors and other health-care providers. ... Medicaid recipients newly insured under the health law are struggling to get appointments or find doctors who will accept their coverage, and consequently wind up in the ER.”

As Dr. Howard Mell of the American College of Emergency Physicians put it: “There was a grand theory the law would reduce ER visits. Well, guess what, it hasn’t happened. Visits are going up despite the ACA, and in a lot of cases because of it.”

Another “grand theory” that Americans shouldn’t buy:

“Free” Medicaid expansion.