Final Days of Federalism
Ten Reasons Why Ohio and Other States Must Not Expand Medicaid or Create Exchanges - And a Fiscally Responsible Alternative
A political prisoner’s dilemma now pressures state governments to do what Washington cannot do by itself— implement the Affordable Care Act (ACA). In order to secure federal funding, many governors and state legislatures believe they must expand Medicaid, but to do so ends in bankruptcy for all.
Driven by a quest to garner federal dollars, over the past 20 years Medicaid spending has expanded to consume state budgets. Yet, in spite of spending more than $407 billion annually, Medicaid currently yields worse patient outcomes than every other form of American healthcare coverage. Medicaid expansion generates dollars for states, not quality care for patients.
However, this growing dependency on federal funding fundamentally changes the balance of power between Washington and the states. Even more, it threatens the very foundations of federalism.