Expansion Analysis: As Goes South Carolina, So Goes Kentucky, Tennessee, Ohio and Others

Just a short note to encourage interested readers -- and those tracking the varying state-by-state effects -- of ACA of 2010 implementation dogfights, to read this morning's New York Times article discussing Gov. Nikki Haley (R). Gov. Haley's inability to carry out her threat -- to keep federal funds out of South Carolina, even for the neediest medical cases -- is clearer, day by day. The Refusnik stance is being dismantled, state by state, and day by day, through backdoor expansions in definitions -- by rule -- of who will be eligible for Medicaid. And those are increasingly federal rules -- passed down to the states, for implementation -- along with earmarked federal funds to implement the changes. Sweet.

The analogs for this -- in other Republican led states -- will not be one for one, but the general theme will very likely play out: eventually, all of these states will end up covering more and more people of limited means, using allocated federal money. That will happen through the October 1 start date for the federal exchanges, or through increases in eligibilty definitions, as a backdoor to outright in-state comprehensive Medicaid expansion. Maybe I should call those, um. . . metaphors -- for what is happening in South Carolina -- but the theme is likely to hold true in broad strokes. And that is a good thing for the nation.

Here's a bit -- do go read it all:

. . . .In her State of the State speech in January, Gov. Nikki R. Haley, a Republican, said, “South Carolina will not implement the public policy disaster that is Obamacare’s Medicaid expansion.” And she boasted of her stance at a recent rally announcing her bid for re-election. “When it came to Obamacare,” she said, “we didn’t just say ‘no,’ we said ‘never.’ ”

The reality, however, is more complex. South Carolina officials say they welcome the prospect that more than a half-million state residents — out of a population of 4.7 million — could soon gain access to affordable coverage, even without the expansion of Medicaid eligibility. And they are working to remake Medicaid so that it does not just pay claims but produces measurable improvements in the health of poor people. . . .

Have a great weekend, one and all!