Quantum Windbag
Gold Member
- May 9, 2010
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What is not in error is that the states end up, whether by hook or crook, funding a significant portion of MEDICAID .
That's because Medicaid is a state-administered program. Your "inadvertent reference" seems to extend into conceptualizing Medicaid as "Medicare for the poor." It isn't. There's one Medicare program; there are, however, 50-odd Medicaid programs. The reason, of course, is that states design their own Medicaid programs. Nowhere is this more true than in Arizona, which operates its entire program under an 1115 demonstration waiver, which is just about the maximum flexibility you can get and still receive federal money.
Where the feds enter the picture is with financial assistance to states: if the state agrees to meet (fairly low) standards, the feds will give them at least a dollar--and, for all but the wealthiest states, it's more than a dollar--for each health dollar the state spends on its qualifying populations. In other words, states trade some amount of flexibility (while still retaining a large amount) for a good sum of federal matching funds. Every single jurisdiction has judged this tradeoff to be a good deal, which is why every single one has chosen to pursue it.
Those that have done analysis in the wake of the ACA to examine whether this will no longer be a good deal with the new eligibility requirements in 2014 has ended up concluding that, indeed, it's still a good deal for the state and forgoing the federal money in exchange for total programmatic flexibility is not in the best interest of the state.
States fund a good portion of Medicaid because it's their program. A more accurate way to put it is that the federal government funds 50%+ of every state's unique medical assistance program.
So, where the feds get the money, the Tooth Fairy?...Lucky the Leprechaun?...Santa Claus, maybe?
They have plenty of paper to print money on, they never run out.