“States already struggling to get by will face even tighter fiscal constraints thanks to yet another costly Obamacare mandate. A study last week from the Kaiser Commission on Medicaid and the Uninsured revealed President Obama’s health care takeover would dump $1 trillion in new costs on federal and state taxpayers over the next decade.”

“While other Republican governors are starting to back away from their opposition to implementing a key part of President Obama’s health care law, Louisiana Gov. Bobby Jindal said Tuesday that he’s not reconsidering.”

“To recruit more doctors to treat the poor, President Barack Obama’s health law took a simple approach: temporarily pay doctors more money… But implementing the raise is not so simple… With two months to go, doctors, state officials, and Medicaid managed care plans say there are numerous details still to be worked out.”

“We are about to spend $1.8 trillion over the next ten years insuring about 32 million people. About half of the newly insured will go into Medicaid and half will get private insurance. If the above chart is to be believed, which half you’re in makes a real difference. That tiny little sliver of difference between the green line and the red line is the differential survival between those who are uninsured and those who are in Medicaid. Even after five years, the differential survival is a little more than 1%.”

“Leaders of the deeply conservative state say that even if Mississippi receives boatloads of cash under President Barack Obama’s health care law, it can’t afford the corresponding share of state money it will have to put up to add hundreds of thousands of people to the government health insurance program for the poor.”

“Nearly half of the people ObamaCare is supposed to cover will be enrolled in the Medicaid program. Past research by Obama health advisors, Jon Gruber and David Cutler, have found that half to three-quarters of newly enrolled, Medicaid enrollees were previously insured with private coverage — often this is because employers dropped the employee health plan knowing Medicaid would pick up the slack. Studies have found Medicaid coverage is inferior to private coverage.”

“PPACA is poised to radically expand Medicaid coverage beginning in 2014—adding to an already crushing state burden of Medicaid costs. The “perfect storm” of Medicaid overspending, excessive regulation, and PPACA expansion is leading to serious discussions among governors and state Medicaid directors about block-granting federal Medicaid funding in return for significant state flexibility in Medicaid program design and administration.”

“Despite efforts by state and health plan officials to smooth the transition, caregivers and others reported ‘the managed care system … was not prepared’ to care for the population’s specific needs, which include complex cases involving mental illness, homelessness and developmental disabilities, the report said… The report about California’s experience comes as the U.S. Centers for Medicare and Medicaid Services (CMS) is ramping up plans to move many of the nation’s 9 million ‘dual eligibles,’ who qualify for both Medicaid and Medicare, into managed care plans.”

“Such human misery, multiplied by tens of millions of people, rolls up into a bureaucratic colossus of breathtaking complexity. Running a Medicaid program involves coping with a jungle of paperwork, cacophony of regulations and, worst of all, sanctimony in nearly every conversation with every stakeholder. It requires constant vigilance against scam clinics, crooked providers, rogue labs, pill mills, vaporware vendors, and a scuzfest of health care bottom-feeders. A successful day in the Medicaid ‘business’ is measured not by goals achieved but catastrophes averted.”

“Because ObamaCare relies heavily on Medicaid — the federal/state program that provides health insurance for the poor — to expand coverage. But Medicaid is already swallowing up state budgets, forcing states to cut back on everything else, especially support for two- and four-year public colleges.”