The Affordable Care Act is here to stay. With the Supreme Court ruling last June and President Obama’s re-election in November, the law has no more legal hurdles left to jump.
For that reason, the big decision before states this year is whether or not to expand Medicaid. Chief Justice of the United States John Roberts ruled that the federal government must give states a choice, so the Obama administration has made the offer as enticing as it can: 100 percent of the costs of the expansion population (up to 20 million people) would be covered from 2014 to 2016, and the federal match would never fall below 90 percent after that. That means, according to some estimates, states as a whole would spend as little as $8 billion to expand over the next decade, while the federal government would spend up to $800 billion. But the politics of embracing Obamacare could be tricky for some states. Matt Salo, executive director of the National Association of Medicaid Directors, has called the expansion “one of the biggest public policy decisions of our generation.”
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