As part of trying to expand health insurance to uninsured Americans in 2010, when President Obama and Congressional Democrats created the Affordable Care Act in 2010, They put in a Medicaid prevision that required states to expand their Medicaid rolls by roughly twenty-million people. Democrats and I’m one of them, that by in large supports the ACA, added another unfunded mandate, meaning the Federal Government requiring States to do something, without giving them the resources to pay for it.
They added a new unfunded mandate to a program that’s already an unfunded mandate. The economy is not great today and states are still strapped, but the economy was worst in 2010. Roughly 2M more people unemployed in 2010 then today. Whether the Medicaid Prevision in the ACA is unconstitutional or not, I’m not a lawyer and that’s above my pay grade, but to me anyway all unfunded mandates should be Unconstitutional, whether they are now or not.
But the point is the unfunded mandate in the ACA is just bad law pure and simple. The goal of the ACA was to expand health insurance for the uninsured who can’t afford it. To be eligible for Medicaid, you have to be living in poverty. A lot of the people who can’t afford health insurance today aren’t in poverty at least by definition. But can’t afford health insurance through their employer or on their own. But make too much money to be eligible for Medicaid. And in the ACA 20M out of the 30M, that were going to get Health Insurance, were to get it through Medicaid.
The Medicaid prevision of the ACA is just another example of why Medicaid was never designed properly from the first place. It was designed to be a health insurer for low-income Americans, that would be controlled by the Federal Government, but that the States would have to implement. What Uncle Sam would want them to do or pay a financial penalty for not taking the Medicaid expansion.
Unlike Medicare that was designed to a Federal health insurer run by Uncle Sam that is paid for by an increase in the payroll tax. I believe both Medicaid and Medicare are overly centralized. And that the States should have the authority to set up their own Medicaid and Medicare systems. With the resources to run them with the Feds serving as a regulator not operator.
Back in 1965 when Medicaid was created, it should’ve been set up as a health insurer for the poor but that was run by the states, or they would regulate it, that was self-financed so it wouldn’t have to be a financial hole that it is today and that would only cover the basics that people need to survive and to be healthy and it could’ve served as a model for health insurers ever since. And not be so expensive to run, with states wondering how they are going to pay for it.