Roberts Medicaid Expansion Opt Out Makes GOP Block Grant Plan More Difficult

In an irony worth savoring, it looks like Supreme Court Chief Justice John Roberts' kowtowing to the Republican right will actually make the GOP's plan to roll back Medicaid that much more difficult. When the whole ACA law came up before the Supreme Court, the four usual suspects on the right voted against it all. Roberts sided with the liberals but his one exception was to allow the states to opt out of Medicaid expansion. (The votes are slightly more complicated than that, but it is generally the gist).

Now that the GOP has total control, they want to block-grant Medicaid to the states, which would allow states to slowly chip away at Medicaid support and give them greater leeway over how they spend the money. In red states, that would probably mean the money is used less for tradition Medicaid and more for partisan pet projects. Additionally, the block grant will never keep up with the rate of medical inflation so slowly but surely Medicaid would erode away.

However, since so many of the red states opted out of Medicaid expansion, that now means that blue states have far more Medicaid recipients. Since block-granting would require the grants to be based on actual Medicaid enrollees, red states would actually see a cut in their Medicaid grants while blue state would receive more. On the other hand, if they just revert to the pre-Obamacare levels of Medicaid, the few red states that did expand would now see a cut as would those blue states. Either way, some red states will see cuts. The GOP representative in charge of coming up with a block grant solution says, "What I thought was going to be easy was I thought Medicaid, we’d just block-grant it to the states. That one actually is going to be a little harder than I thought. The reason is there are states like New York, states that expanded [Medicaid]. How do you cover that 10 or so million people on Medicaid?" Of course, this doesn't necessarily stop the GOP from going ahead with the block-grant plan, but it is somewhat amusing to see them struggle with the issue of who to essentially screw.

If only John Roberts hadn't allowed states to opt out of Medicaid expansion, none of this would be an issue now. The GOP could go right ahead with their block grant plan without any cuts to red states. Instead, Roberts threw a bone to the right wing and now the GOP in Congress is choking on it. In these dark days, there is some delight in that irony.