The 26 states that led the Supreme Court challenge against the law argue that expansion unfairly burdens them by putting them on the hook for higher Medicaid costs down the line. But states say that, even if the court strikes down the Medicaid expansion, the program will still be unmanageable, because the weak economy has caused the number of residents who rely on it to mushroom.
In Colorado, about 615,000 residents were on Medicaid by late last year, a record high for the state and a 57.7% increase from January 2007. The state cites hard economic times, coupled with its own eligibility expansion, for the uptick.
In Texas, the Medicaid program currently faces an approximately $4 billion budget shortfall, even after recent cuts to services. The number of residents who qualified for the program doubled from 2000 to 2011. Texas officials say the federal law would leave it in even worse shape because it would have to cover another 1.8 million low-income Texans.
A handful of states are striking out on their own to come up with a solution to high costs and the uninsured. Vermont is setting up its own plan that would go much further than the federal health law, and by 2017 give the state a Canadian-style, single-payer system.
A new state entity, Green Mountain Care Board, is crafting a plan to replace Vermont’s traditional insurance model with the state acting as a publicly funded and managed insurer that would pay health-care providers and set reimbursement rates.
Vermont hasn’t figured out how to pay for the system. Critics say the plan could impose burdensome new taxes and restrict residents’ health-care choices, while supporters say it would improve care and lower overall costs.