“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.”

“One of the most tragic failings of ObamaCare is that it will make it harder for many of the most vulnerable citizens – patients with no option but Medicaid – to get care. Medicaid is cumbersome, complex, and wasteful – already the worst health care program in the country. But rather than making changes to improve or modernize this program designed to finance care for the poor, the Obama administration is trying to convince states to add at least 16 million more people to Medicaid, including families making more than $30,000 a year.”

“The Congressional Budget Office (CBO) has just published, in two reports, its updated score of the 2010 health care law. The new score is bad news from almost any vantage point. CBO’s fiscal evaluation of the law is worse than before, even though the number of people receiving health insurance coverage is now projected to be fewer.”

“But as they gathered here this weekend at a meeting of the National Governors Association, most governors in both parties said that faced with a choice they did not expect to have, they needed to study how to proceed with this significant change in federal-state relations. Not all Democrats were leaping at the chance to expand their programs, and not all Republicans were ruling it out.”

“While the resistance of Republican governors has dominated the debate over the health-care law following last month’s Supreme Court decision to uphold it, a number of Democratic governors are also quietly voicing concerns about a key provision to expand coverage. At least seven Democratic governors have been noncommittal about their willingness to go along with expanding their states’ Medicaid programs, the chief means by which the law would extend coverage to millions of Americans with incomes below or near the poverty line.”

“Setting aside the brazen intrusion into state sovereignty and the gross federal overreach, the practical problem with ObamaCare’s Medicaid expansion is that the product the administration is selling is broken. State and federal budgets are simply unable to handle an expansion of this magnitude.”

“So, by refusing to go along with Obamacare’s Medicaid expansion and by blocking state-run exchanges, governors are not just saving state taxpayers money. They are potentially reducing future federal spending by as much as $1.5 trillion over the next ten years. While congressional Republicans have been reduced to taking symbolic repeal votes, and Mitt Romney struggles to determine whether or not the individual mandate is a tax, governors — and state legislators — have become the real heroes of the fight against Obamacare.”