The fight over health reform has plummeted from the stratospheric heights of constitutional jousting to nitty gritty decisions by states over whether they can afford reform. Critics warn states that reform will bankrupt them. The reality: states cannot afford to miss out on the cash and the almost free pass to provide coverage and care for millions of uninsured residents.
The Supreme Court's decision on health reform upheld its constitutionality but gave states much greater freedom in deciding whether to expand Medicaid - the main engine for increasing access. The Court said that states have the option of a lifetime: 100 percent of the costs of expanding Medicaid for all to 133 percent of the federal poverty level for three years, leveling off at 90 percent in 2020. States have to put in a dime to bring in large numbers of their citizens. By contrast, states now put in 43 cents for every dollar of Medicaid coverage.
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