The Supreme Court upheld the health care law. States will begin implementation. States will also decide whether to expand state Medicaid rolls.
The ruling permits states to opt out of that expansion without losing all federal Medicaid supplemental funding. Some states will decide whether to expand solely on ideological grounds with conservatives opposing and liberals supporting.
The decision must instead be made by each state based on its ability to raise revenues to support expansion according to its taxpayers’ ability to pay that revenue. Further, that ability-to-afford decision must consider the future when federal funding of Medicaid expansion declines.
States must also look beyond existing state population. States must concurrently strengthen state residency and eligibility requirements to avoid a massive influx of people who’ll lack the same Medicaid coverage in their states.
Usually home ownership and good jobs prevent many people from moving when they’d like. Many who lack both can and do move frequently to find jobs or to obtain public benefits.
California is an example. Once a rich state with high employment and a population of talented people who voted themselves generous unemployment and welfare benefits, from the late 1950s onward it’s become a magnet for people from states lacking jobs and meager public welfare benefits. And it’s experienced a massive exodus of the middle class unable to keep up with the resulting tax burden.
California today is a state of some very rich and many low income, unable to pay obligations, divided in wealth and politically polarized.