Freedom Line Blog

How big is a “gap” in coverage when it affects 840,000 people?

The Los Angeles Times says that California is racing to pass a “bridge” program into law that helps individuals and families likely to be caught between qualifying for Medi-Cal (the state’s version of Medicaid), and ObamaCare’s new state-based health insurance exchange.

In California, residents earning up to 138% of the federal poverty level, or about $15,000 a year, will be eligible for Medi-Cal next year. Individuals earning up to 400% of the federal poverty level, or about $46,000, will be eligible for subsidies through the exchange, known as Covered California.

The Covered California board approved a plan in March to help patients expected to jump between the two. The “bridge plan” would enable patients now on Medi-Cal managed care whose incomes rise to continue to stay with their health plan once they move to the exchange.

The program, which still needs federal approval and state legislation to take effect, could serve as many as 840,000 people next year. The plan should streamline the process, keep out-of-pocket premiums low and make it easier for people to keep their providers, said David Panush, external affairs director with Covered California. “It is better for their quality of care, it is better for continuity of care,” he said.

While it’s refreshing to see California taking steps to protect people from being penalized for working more, what the article doesn’t mention is how related government policies are putting the squeeze on the state’s working poor.

California’s anti-business climate – coupled with ObamaCare’s perverse incentive structure that makes it more affordable for businesses to cut hours rather than pay hefty premium increases for employee’s health insurance – are underreported tax increases on the working poor.

By diminishing the number and quality of jobs available to people at the bottom of the employment ladder, certain public policies make it exceedingly difficult for people to work their up into a better standard of living.

Because of this, one way to think of the constant tinkering and enlargement of public benefits is as a way to compensate the working poor for taking away their access to an abundance of jobs where they can get the experience and skills needed to move upward an onward.

Under the current regime, a “bridge” program between Medi-Cal and Covered California is the least state policymakers can do. Still, those entangled in the state’s safety net deserve better.

As I discuss in my column this week, the primary beneficiary of HHS Secretary Kathleen Sebelius’s legally suspect lobbying of private health companies is the non-profit community organizing outfit Enroll America.

The group’s Advisory Council includes several members of the liberal establishment such as NAACP, La Raza, Planned Parenthood, and the Service Employees International Union (SEIU).

But wait, there’s more:

“Enroll America’s board of directors is made up of insurers and hospital organizations that will benefit from enrolling millions of people in Obamacare. But its management is 100 percent political. Its president is Anne Filipic, formerly deputy director of the White House Office of Public Engagement, where she networked with community organizers. Before that, she had a top job at the Democratic National Committee, and before that she managed Obama’s victorious 2008 Iowa Caucus bid,” according to the Boston Herald.

“To design a media campaign, Enroll America hired Lake Research, which also manages messaging for ACORN, MoveOn.org, LaRaza and 39 members of Congress, all Democrats”

At least now we know how Sebelius is feathering her post-HHS nest – by funneling money to just about every radical liberal group in America.

A group of powerful Republicans in the House and Senate is demanding an investigation into potentially illegal fundraising calls by HHS Secretary Kathleen Sebelius to private health companies.

In a letter to the Government Accountability Office, three House committee chairmen and two Senate ranking members said, “The Secretary’s actions show an apparent disregard for constitutional principles and may violate the Antideficiency Act, the prohibition against augmenting congressional appropriations, and executive branch ethics laws,” according to reporting by Politico.

As I explain in my column this week, Sebelius has been caught quoting specific dollar amounts that private companies should donate to a pro-ObamaCare community organizing group getting ready to promote the law ahead of this year’s October enrollment.

Whatever GAO decides to do, it’s a near certainty that the relevant Republican-led House committees with jurisdiction over this scandal will soon launch investigations into Sebelius’s conduct.

Sally Pipes identifies an “escape hatch” for small businesses trying to avoid the costly employer mandates threatening employers with costly insurance premiums or fines:

A RAND analysis found that a fifth of firms with 50-200 workers had self-insured by 2010, the year Obamacare became law — up from 14 percent of such companies in 2006.

A survey by Munich Health North America found that 82 percent of health insurance executives report seeing growing interest in self-funded coverage among employers. A California-based benefits consulting firm that helps companies self-insure told Kaiser Health News that its business has doubled in the past six months. And Cigna says that it saw self-coverage for small businesses grow by a fifth last year.

Companies with younger, healthier workforces are leading the way. After all, with their population of low-risk employees, they have the most to gain. And that’s bad news for Obamacare’s exchanges.

The problem for ObamaCare is that the only way health insurance premiums will be (theoretically) affordable is if legions of young, healthy people join the exchanges’ insurance pools. That’s because they are needed to pay into the system so that older and sicker people can draw down the benefits.

But if small businesses opt to self-insure – especially if they are newer businesses more likely to employ younger and healthier workers – then that will drain the ObamaCare pools of the very people who will make them (barely) affordable.

With this in mind, don’t be surprised to see an IRS or HHS rule come down that prohibits self-insurance to prop up ObamaCare’s exchange pools.

As with the so-called “family glitch,” it’s a ploy the Obama administration will be ready to use if its slapdash law continues to produce embarrassing unintended consequences.

On the heels of a Washington Post report that HHS Secretary Kathleen Sebelius is actively soliciting health industry executives for six- to seven-figure “donations” to help publicize ObamaCare, the New York Times reveals how much she’s netted in pledges so far: $10.5 million.

And that’s just from two groups. One is the Robert Wood Johnson Foundation which bills itself as the largest public health philanthropy. It pledged $10 million. The other is the for-profit tax preparation company H&R Block who, according to the Times, “sees a large role for itself in helping low- and middle-income people apply for tax credits that can be used to buy private health insurance.” It promised $500,000 for the propaganda outreach effort.

An unbiased observer could look at this and easily see at least the probability if not the certainty of a quid pro quo arrangement where payment to an HHS-backed initiative now means preferential treatment later.

And remember, these two transactions are only the tip of the iceberg. Once more health industry entities confirm their involvement Sebelius’ project we’ll be able to see which firms will reap the lion’s share of benefits of ObamaCare’s corrupt pay-to-play scheme.

Crony capitalism is alive and well in the Obama Administration.

Earlier this year Michael Barone catalogued a litany of abuses to the rule of law perpetuated under the Obama Administration. “Gangster Government” is the term Barone coined to describe the behavior.

As of Friday, Barone needs to update his list.

Sarah Kliff broke the news that Kathleen Sebelius, Secretary of Health and Human Services, has been calling health care executives, “asking them to make large financial donations to help with the effort to implement President Obama’s landmark health-care law…”

Imagine the conversation. A health care CEO gets a personal call from the chief regulator of his business suggesting that the company and the people it employs make financial donations to promote a law administered by the regulator.

Sounds like a suggestion that can’t be refused, right?

As Barone would say, this is Gangster Government.

Republicans in Congress need to push back hard on this abuse of power by Sebelius.

The people running businesses are there to make profits, not spend precious resources on ruinous fights with thugs spending taxpayer money.

If Sebelius can get away with coercing businesses to “donate” money to promote a law that increases her power over them, an awful precedent will be set. She – and any of her successors – will be able to tax, fine and now “fundraise” the very people they regulate.

Fail to pay enough, and say goodbye to your livelihood.

Congress needs to put a stop to Sebelius’ abuse of power. Now.

The editors at National Review Online give some much-needed advice to the congressional GOP:

“The basic outline of a workable strategy is easy to draw up. First, Republicans should explain why Obamacare is unlikely to work. Second, they should finally unite behind an alternative that would let at least as many people get coverage as Obamacare but without the law’s side-effects. Third, they should say that they plan to repeal and replace Obamacare as soon as they can do so — whether in one fell swoop, which could occur only under a new president in 2017, or one step at a time. Fourth, they should advance bills that both replace parts of Obamacare and highlight its flaws.”

The most perplexing thing about congressional Republicans is that no one has stepped forward to be the Paul Ryan of health care reform. Ryan spent years in the background learning the federal budget process to construct a clear, workable reform that slows down the growth of entitlement spending while making Medicare and Medicaid more market friendly.

With ObamaCare on the books since 2010, it’s a wonder that no Republican in the House or Senate has taken on the responsibility of putting together an alternative that the GOP can rally around. To my knowledge, no one – not the 16 Republican physicians in Congress or anyone on a relevant committee – is taking steps to make sure there’s a workable replacement in the event conservatives get their wish and repeal ObamaCare.

It’s not enough to be right that ObamaCare is wrong on the merits and impossible to implement. There’s also got to be a contrasting vision of health care reform that is better than ObamaCare.

As of now, we’re still waiting.

And the hits just keep on coming.

After news broke that the leadership in both the House and Senate were conspiring to exempt themselves from ObamaCare’s costly insurance exchanges, we’re told that the problem isn’t Congress shirking responsibility for a law it passed.

It’s worse.

The real issue, according to reporting by health policy expert Ezra Klein, is that Congress is too stupid to write a law clear enough to know what it does.

Per Klein:

“Here’s how it happened: Back during the Affordable Care Act negotiations, Sen. Chuck Grassley (R-Iowa) proposed an amendment forcing all members of Congress and all of their staffs to enter the exchanges. The purpose of the amendment was to embarrass the Democrats. But in a bit of jujitsu of which they were inordinately proud, Democrats instead embraced the amendment and added it to the law.
…
“So Grassley’s amendment means that the largest employer in the country is required to put some of its employees — the ones working for Congress — on the exchanges. But the exchanges don’t have any procedures for handling premium contributions for large employers.

“That’s where the problem comes in. This was an offhand amendment that was supposed to be rejected. It’s not clear that the federal government has the authority to pay for congressional staffers on the exchanges, the way it pays for them now in the federal benefits program. That could lead to a lot of staffers quitting Congress because they can’t afford to shoulder 100 percent of their premiums.”

Got that?

Rather than think through how an amendment would alter the structure of a law that, as one of its architects put it recently, “is probably the most complex piece of legislation ever passed by the United States Congress,” Democrats opted to play games. No wonder the lead author of the law sees “a huge train wreck coming down.”

Whether it’s a fine that’s really a tax, a “family glitch,” or now an ambiguous gap in coverage, ObamaCare’s so-called drafting errors are making it one of the worst written laws ever.

And now the other shoe drops.

Less than a week after telling HHS Secretary Kathleen Sebelius that her implementation of ObamaCare’s costly and confusing health care system is a “train wreck,” U.S. Senator Max Baucus (D-MT) announces he’s retiring.

Baucus’s comments caused a stir because they met the Washington, D.C. definition of a gaffe – telling the truth in public.  With the Chairman of the Senate Finance Committee, and lead ObamaCare author, on record as criticizing the President’s signature policy, it looked like it might finally be acceptable for Democrats in Congress to admit the obvious: ObamaCare is a disaster in the making.

But rather than stick around and fight to reform the law, Baucus is choosing to bow out of a tough reelection campaign in 2014. The decision could make it much easier for Republicans to pick up the seat, potentially adding another vote to the conservative-led repeal caucus.

Whatever the spin, this much is clear. Last week Baucus let it be known he could no longer defend the law. Now, it’s clear he can’t win with it either.

Hopefully, it’s the start of a trend.

Robert Costa says that if the Senate passes the Gang of Eight’s comprehensive immigration reform bill, the House of Representatives stands ready to put the brakes on the latest piece of “must pass” legislation. Their mechanism: Regulator order.

“Regular order” allows House Republicans to dictate the pace of legislation and makes “grand bargains” of any sort harder to pass. Consider immigration. Several sources close to the leadership say that even if the Senate passes something on immigration, the bill will be immediately sent to the committees, and then either sent back to the Senate with changes, or rewritten in a bicameral conference committee. This means that the chance of the Senate’s Gang of Eight bill coming to the House floor, as is , is nearly non-existent. House Republicans would first have to mull it, schedule hearings, and then tinker with its legislative language .

That tweaking process could take months, which is just fine with many Republicans, who’d like the public to have as much time as possible to chew over the controversial elements of Obama’s prized bills. The caucus consensus is: The more time Congress takes to consider a bill, the more time the public has to sour on its components.

Unlike ObamaCare where Nancy Pelosi’s Democratic majority rubberstamped the Senate’s rewrite of the nation’s health insurance market, House Republicans want to make sure they know exactly what’s in the Gang’s immigration bill before voting on it.

If necessary, House Judiciary Committee Chairman Bob Goodlatte (R-VA) is even floating the idea of breaking the Gang’s carefully balanced 1,500 page bill into separate pieces. That way, the most popular measures – such as enhanced border security measures – would likely become law, leaving less desirous elements out until supporters can figure out a way to sell them to the American people.

For a caucus that runs only one-half of one branch of government, regular order sounds like a good strategy to employ.

Hat tip to Investor’s Business Daily for pouncing on what will be a very unpopular unintended consequence of passing the Senate Gang of Eight’s immigration reform bill:

Under the immigration reform bill, some employers would have an incentive of up to $3,000 per year to hire a newly legalized immigrant over a U.S. citizen.

In avoiding one controversy — the cost of providing millions of newly legalized immigrants with ObamaCare subsidies — the Senate “Gang of Eight” may have risked walking into another.

The bipartisan legislation released Wednesday dictates that those granted provisional legal immigrant status would be treated the same as those “not lawfully present” are treated under the 2010 health law.

That means they would neither be eligible for ObamaCare tax credits nor required to pay an individual tax penalty for failing to obtain qualifying health coverage. It also means some employers would face no penalty for failing to provide such workers affordable health coverage.

So, in order to avoid the charge that legalization would give illegal immigrants citizen-like access to ObamaCare subsidies, the Gang of Eight simply bars them from access. But that means that legalized immigrants are cheaper to hire than comparable native-born workers who will be competing with more people for less jobs.

There may be a fix, but it will be messy.

Good luck with that.

Don’t look now, but with ObamaCare failing to deliver on its promises before it even takes effect, Democrats are already starting to lay the blame on the one party least responsible for this policy monstrosity: Republicans.

Kathleen Sebelius, Secretary of Health and Human Services and the point person for ObamaCare’s implementation, told a Harvard School of Public Health audience that instead of saying, “let’s get on board, let’s make this work,” Republican opponents coerced her into fighting “state-by-state political battles.” Sebelius complained, “The politics has been relentless,” according to Investor’s Business Daily.

This from the woman whose refusal to honor the conscience rights of religious employers elevates the right to “free” contraception over the First Amendment.

But just because Sebelius’ charge that ObamaCare’s completely foreseen failure is actually Republicans’ fault is laughable to anyone who knows the facts, don’t assume that the GOP communications apparatus can be counted on to frame those facts effectively.

After all, this is the same universe of consultants and staff that got outmaneuvered last election season on liberal talking points like the GOP’s “War on Women,” and Mitt Romney’s “47 percent” comment.

If the Left wants to present Sandra Fluke and “The Life of Julia” as exemplars of modern feminism, why can’t the Right counter with the common sense observation that what liberals really want is a government sugar-daddy who pays for sex and then subsidizes any consequences thereafter?

And rather than deny that 47 percent of Americans don’t pay federal income taxes, why don’t Republicans instead hit back with the explosive growth of food stamps and the unprecedented extension of unemployment benefits in the Age of Obama?  Throw in the Obama Phone mentality, and people will start to understand that there are real costs to the liberal vision of welfare.

All this to say I hope Republicans have learned their lesson about how to contest Democratic smear campaigns.  It would be a shame if when ObamaCare comes off the rails next year the GOP fails to capitalize electorally because no one clearly makes the case that only liberals are to blame for the mess they created.

States looking for flexibility under ObamaCare in how to structure and pay for expanding Medicaid can take a hike, according to an analysis by the Heritage Foundation.

States like Arkansas and Indiana have requested waivers from the health reform law’s expansion formula that creates millions of new enrollees at an eventual cost of billions of dollars to states.

The hope was to use existing state-based models like Indiana’s successful health savings account for low-income Hoosiers to increase Medicaid enrollment while retaining cost certainty for state budget writers.

But those hopes were dashed after the federal Department of Health and Human Services released a frequently asked questions (FAQ) sheet that flatly denied any request to deviate from ObamaCare’s one-size-fits-all, open-ended spending commitment for Medicaid.

With this announcement, the Obama administration has definitively articulated its idea of bipartisan reform.  Republican governors who capitulate and get in line are welcomed with open arms.  Those like Indiana’s Mike Pence can take their policy entrepreneurship somewhere else.

Fox News is reporting that the implementation of one of the two state-based, federally-regulated health insurance exchanges is being delayed for an entire year (2015 instead of 2014).

The decision applies to the exchange that will be created to let small businesses shop for affordable insurance policies, not the similar and more well-known exchange for individuals and families looking for insurance.

While it would be easy to blame poor planning and bad execution on the part of the federal government, another explanation seems just as likely.

As originally written, ObamaCare contained a so-called “public option” that would have been offered by the federal government on the exchange as competition with private alternatives.  Conservatives opposed the public option because it threatened to undercut private competitors with an artificially low price since the government, unlike a private business, doesn’t have to make a profit.

After a few years of running private businesses out of the market with artificially low prices, conservatives reasoned, the public option would become the only option as more and more consumers opted for a deal that would be too-good-to-be-true.  When that happened, government could claim the market failed, paving the way for a government-run, single-payer health system.

Of course, the public option was stripped out of the final version of ObamaCare.  But the intent to move America toward government-run health care did not.  Since there’s no requirement under the law for small businesses to provide health insurance, many may now stop bothering if the small business exchange is delayed.  That puts their employees on the individual and family exchange, which as estimates are showing, will cost people much more than originally advertised, even including the government subsidy.

With private insurance unable to deliver a product that covers the heightened floor created in ObamaCare that is also affordable for the people required to buy it thanks to the individual mandate, don’t be surprised if activists and policymakers start clamoring for government to declare a market failure and nationalize the system.

Such a scenario may sound far-fetched, but can anyone seriously say that with the Obama Administration in charge that it’s not at least possible?

The Indianapolis Star reports that Indiana Republican Governor Mike Pence, a possible 2016 presidential candidate, cleared an important hurdle today when the state’s House Public Health Committee approved a bill to expand Medicaid eligibility without relying on ObamaCare’s open-ended spending incentives.

Pence’s plan would increase Indiana’s Medicaid enrollment by an estimated 400,000, but within the state’s Healthy Indiana initiative begun in 2007.  As a health savings account, Healthy Indiana allots a certain amount of money to qualifying Hoosiers who then shop for doctors and treatment options within their budget.  In effect, it transfers the decision making process for health care away from government bureaucrats to private citizens.  By capping the amount, Healthy Indiana also gives state budget writers more certainty about the cost of Medicaid expansion in future years.

Contrast this with the unlimited spending commitment envisioned by the Medicaid expansion system under ObamaCare, and conservatives will see why Pence’s proposal should be watched closely.  Under ObamaCare, states would pay no cost for expanding their eligibility pool up to 138 percent of the federal poverty line.  But starting in 2017, those that expanded enrollment would pay for 10 percent of the increase.  Though seemingly a small percentage, the costs will run into the billions, with even more likely if the federal government decides to reduce its 90 percent subsidy, as President Barack Obama has already hinted at doing.

The future of health insurance reform looks like it will include some mix of government-regulated exchanges, subsidies, and cost controls.  The question dividing conservatives like Mike Pence and Paul Ryan on one hand from liberals like Obama on the other, is who gets to make the lion’s share of the decisions on how health insurance dollars are spent.  Conservatives value individual choice, while liberals favor centrally planned mandates.

Ironically, if the President wants ObamaCare to be fiscally sustainable, he’ll have to accept that the only way to do it is allowing conservatives like Pence and Ryan to inject into it as much personal freedom as possible.

With President Barack Obama’s legally required budget proposal arriving two months late (April 10 when it was due February 4), here’s a suggestion to ensure the document is something other than a White House-approved paper weight.

Because of the President’s unprecedented delay, both the Republican House and Democratic Senate have passed budgets, each with only party-line support.  Now that both sides have put their opening bids on the table, it would be wise to make the White House version a kind of third way compromise that includes some elements that both sides like.

One example would be to incorporate Paul Ryan’s idea for putting Medicare plans on a state-based, federally-regulated health insurance exchange.  Then, make the now obvious point that this plan, coupled with ObamaCare’s exchange for non-seniors indicates bipartisan agreement on a major aspect of health insurance reform.  Doing that would help change the focus of the debate on what Republican and Democrats have in common when it comes to moving forward on this issue.

Peter Ferrara, a budget expert at The Heartland Institute, a free market think tank, reminds us where many of Paul Ryan’s ideas on Medicare reform originally came from:

This Medicare reform plan was actually developed by President Clinton’s Medicare Commission, so it had bipartisan support at a time when the Democrat Party had grown ups in influential positions, rather than just adolescent, Marxist, revolutionaries posing in grown up drag.  The legislation providing for these reforms was actually introduced in the Senate by liberal Democrat Sen. Ron Wyden of Oregon.  It has been endorsed by long time liberal academic Alice Rivlin, the Godmother of the CBO, serving as its first director.

Indeed, the plan was developed from an initial proposal in 1995 by two lifelong liberal scholars, Henry Aaron of the Brookings Institution, and former CBO Director Robert Reischauer.  They were the first to propose a premium support system for Medicare in a 1995 article in the journal Health Affairs.  The Reischauer/Aaron concept was later embodied in Medicare Parts C and D in the 2003 Medicare reforms, where they have already worked very effectively.

That’s right – Proposed by liberals, passed by conservatives.

With this in mind, who’s out of the mainstream now?

Kudos to Sarah Kliff at Wonkblog for tracking down a draft copy of an ObamaCare application. It’s the one a person would use to get access to a state-based health insurance exchange, and the subsidies to buy coverage that go along with it.

At 21 pages and asking for lots of sensitive information, the document is likely to be much more cumbersome than most people bargained for. That’s one of the biggest hurdles facing implementation, according to Kliff:

The administration is caught in a bit of a bind here. On the one hand, Obamacare is tricky business. In order to figure out how much Americans will pay, the federal government needs to collect lots of information, everything from the size of the family to its income to whether any family members are Alaska Natives (which would make them eligible for additional services through the Indian Health Service). It’s hard to collect all that data in a way that isn’t a bit complex.

At the same time, the whole goal of the Affordable Care Act is to maximize health insurance enrollment. That puts a premium on making the applications simple and easy to use—not the kind of documents that you’d get half way through and give up on.

To find a space between the two of these, there are likely a lot of support services that will start springing up over the next few months. This could include traditional agents and brokers, whose whole line of business is understanding applications like this one.  The Affordable Care Act also envisions a group of navigators, financed by state exchanges, who will—as the name implies—help navigate the insurance system.

Meet the new middle men, the same as the old middle men.

True, cost-efficient health insurance reform would reduce reliance on “navigators” in order to eliminate the transactions costs they generate. If a product is so hard to buy that it requires help to do so, you can bet that the cost of said product will go up. And up, up, up…

The bright side? At least there will be thousands of health insurance broker jobs that the Obama Administration can claim credit for creating or saving.

Republicans in the Florida house and senate have rejected Governor Rick Scott’s plan to expand the state’s Medicaid population.  Under ObamaCare, states are promised three years worth of federal funding to cover the cost increases.  Last week, Scott reversed his earlier opposition and accepted those terms.

The move by Florida’s Republican legislators is a welcome corrective to the knee-buckling capitulation of Scott and other GOP governors.  Borrowing a play out of Rep. Paul Ryan’s budget proposals, State Senator Joe Negron is using his no vote to pivot in a new direction.

“This will be the beginning of a transformation of the entire Medicaid system,” committee Chairman Sen. Joe Negron said. “My goal is that we will get out of the federal Medicaid system as we know it. Now, we can’t do that all at once, but we have an opportunity to begin that process.”

Negron wants the state to create a basic health insurance plan for the expanded Medicaid population and require recipients to pay a sliding scale premium based on their income. He suggested using Florida Healthy Kids, a managed care program that provides health insurance to low-income children, as the vehicle for delivering the new system.

Negron and his colleagues are showing real policy leadership.  Now that Scott’s dash for cash is on hold, it’s time for the former health care executive to rediscover his private sector creativity and help Negron put Florida on a path toward sustainable social safety net spending.

H/T: Tampa Bay Online

Pennsylvania Republican Governor Tom Corbett may be wavering on his refusal to expand Medicaid under ObamaCare’s bait-and-switch funding scheme.

I don’t envy him.  He’s surrounded by states like Ohio and New Jersey, whose GOP governors opted to indulge the fantasy that they can accept the federal government’s promise of full funding at face value.

To his credit, Corbett isn’t allowing himself to act like there are no costs associated with agreeing to so-called “free” Medicaid expansion for the next three years.

Here’s some refreshing honesty from Corbett’s spokeswoman Christine Cronkright:

The Corbett administration has estimated that participating in the Medicaid expansion that would add 800,000 people to medical assistance would cost Pennsylvania $1 billion through 2014-15 and a total of $4.1 billion. Advocates maintain that the Medicaid expansion would pay the way for $43 billion in federal contributions, beginning with three years in which the federal government would pay 100 percent of the expansion.

“Regardless of the federal government’s claims, the presumption that they will cover 100 percent of the costs of full expansion is simply not true. Regardless of any other costs under the (Affordable Care Act) that we’d have to bear, there are still IT and staffing costs, costs for additional clients coming into the system that may have been eligible before, and costs for those we believe will drop employer-based coverage,” Cronkright said.

So it turns out “free” really means $1-4 billion.

The simple truth about ObamaCare’s Medicaid expansion is that it establishes a one-way street toward greater federal intervention in every individual’s health care decisions. Democrats know this, and are using the “free” money trope to lure weak-willed Republicans into a federally-dominated system from which a state will not be able to extract itself.

GOP governors who agree to expansion and believe that they will have the political support to simply cut off access to Medicaid when the feds pull back funding are deluding themselves. Besides, what kind of leadership is it to support welfare expansion on the condition that someone else pays for it with their debt-laden credit card?

So far, Governor Corbett is standing firm in the face of tremendous opposition to fiscal sanity.  Let’s hope he continues.