Clarification about the Medicaid part of AFA

As I heard it explained on MSNBC today, the Medicaid extension issue that was found invalid by SCOTUS may be a more important loss than initially believed.

That provision of the Affordable Care Act was for a big expansion in the number of people covered by Medicaid -- perhaps a major portion of the increased number of people who would have health insurance.   The federal government would provide grants to the states (as it does now for Medicaid) for the expansion and, in return, require the states to contribute also.   The ACA included a provision that, if a state did not comply with its share of the expansion, all its federal funding for Medicaid would be withdrawn.

What this decision does is simply say you can't withhold the funds for the basic Medicaid part if a state chooses not to co-operate with the expansion.   In effect, it makes the expansion an option for each state.    It could have no effect at all, if states choose to do their part.  But, in this time of state budget crises, it's likely many will take that option not to comply.  In fact it was the lawsuit by 26 states on this issue that brought the case to SCOTUS.

ACA provided both a carrot and a stick to induce state cooperation.  Now only the carrot remains (federal funds);  SCOTUS removed the stick (penalty loss of all Medicaid funds).

How much will this really affect the number of new people who were projected to be covered by insurance under ACA?    Is it fixable some other way?

Stay tuned.

Ralph