Across the nation, both Medicaid funding and Medicaid enrollment has plummeted following 2010 decreases in federal support to state Medicaid programs. (1)  Medicaid programs have crippled state economies across the nation causing states seek protection against a Medicaid the Obama administration wishes to greatly expand. (2)

Arizona’s Medicaid struggle

Arizona Governor, Jan Brewer, signed legislation formally seeking to remove 280,000 from the state’s Medicaid program. (3), (4)  Dozens of governors have asked the federal government to repeal the   maintenance-of-effort provision, but the measure signed by Gov. Brewer on January 21st makes Arizona the first state to seek a waiver against the federally mandated health care reform requirement to maintain current Medicare levels. 

Under the measure, Arizona will save $541 million over the fiscal year.  Opponents of the measure are quick to point out that the state will lose $300 million in federal support and in turn have sought a proposition to impose a 1% tax against the rich as a form of health tax.  The new health tax will be levied against individuals making $150,000 and couples making $300,000 a year. (3)  Unfortunately, such struggles with budget and government sponsored health care are not unique to Arizona.

Though Arizona has taken the forefront in certain aspects of the Medicaid conundrum, other states are seeking protections against Medicaid differently.  Following after California, 22 states are seeking the legal right to reduce Medicaid payment rates payable to health care providers who accept Medicaid patients. (6), (7)  This has spawned the obvious concern. 

National Medicaid struggle

In the wake of decreasing Medicaid pay rates, fewer health care providers will accept Medicaid as a payor source creating even further access issues that exist in state sponsored health care.  Health care providers echo the same concern and claim that cuts in Medicaid rates would drive them away from Medicaid patients citing they would not be able to afford to provide care to them. (3), (8)  Despite the concern, the states feel that without cutting Medicaid, they have nowhere within their state budgets to cut without causing grave economic harm to their citizenry. (9), (10)

Further complicating the matter for the individual states is the expansion of Medicaid under ObamaCare.  States cannot maintain their current Medicaid programs and fear that the forced expansion of the program will cause irreversible fiscal damage to economically stricken states. (11)  This has forced 27 states to file law suits against a federal government that has already had health care reform deemed unconstitutional by the federal court. (12)

For many Arizonans and Americans it is clear the future of Medicaid rests on the ability of the state and Obama administration to resolve the shortcomings that lie within health care reform.  While repeal of ObamaCare continues to gather support, a myriad of problems exist that need corrective action that only a united government can provide.

Published January 25th, 2010 on Examiner.


1. data, Kaiser Commission on Medicaid and the Uninsured using CMS and KCMU. Change In Total Medicaid Spending And Enrollment, 1998-2011 . s.l. : Kaiser Commission on Medicaid and the Uninsured, 2010.

2. Johnson, Paul. The Repeal of Health Care Reform. Suite 101. [Online] 01 19, 2011. [Cited: 01 24, 2011.] http://www.suite101.com/content/the-repeal-of-health-care-reform-a334774.

3. Rough, Ginger and Reinhart, Mary K. Brewer signs law seeking Medicaid waiver. AZ Central. [Online] 01 21, 2011. [Cited: 01 23, 2011.] http://www.azcentral.com/news/election/azelections/articles/2011/01/21/2....

4. Davenport, Paul. Brewer proposes cut in Medicaid enrollment. AZ Central. [Online] 01 12, 2011. [Cited: 01 21, 2011.] http://www.azcentral.com/news/election/azelections/articles/2011/01/14/2....

5. Reinhart, Mary K. Arizona hospitals now support tax on revenue. The Arizona Republic. [Online] 01 25, 2011. [Cited: 01 23, 2011.] http://www.azcentral.com/arizonarepublic/local/articles/2011/01/25/20110....

6. Doyle, Micheal. Supreme Court takes on states' plans to cut Medicaid payments. The Kansas City Star. [Online] 01 18, 2011. [Cited: 01 21, 2011.] http://www.kansascity.com/2011/01/18/2593190/supreme-court-takes-on-stat....

7. Ramshaw, Emily. High Court To Decide If States Can Cut Medicaid Rates. The Texas Tribune. [Online] 01 20, 2011. [Cited: 01 21, 2011.] http://www.texastribune.org/texas-taxes/budget/high-court-to-decide-if-s....

8. Galewitz, Phil. States Cutting Medicaid Benefits As They Stagger Under Economic Downturn . Senior Journal. [Online] 10 04, 2010. [Cited: 01 21, 2011.] http://seniorjournal.com/NEWS/Medicaid/2010/20101004-StatesCuttingMedica....

9. Blase, Brian. States Cry to Washington: Remove Obamacare’s Medicaid Handcuffs. The Foundry. [Online] 01 11, 2011. [Cited: 01 21, 2011.] http://blog.heritage.org/2011/01/11/states-cry-to-washington-remove-obam....

10. Nix, kathryn. http://www.heritage.org/Research/Reports/2010/04/ObamaCare-Impact-on-the.... The Heritage Foundation. [Online] 04 20, 2010. [Cited: 01 21, 2011.] http://www.heritage.org/Research/Reports/2010/04/ObamaCare-Impact-on-the....

11. Smith, Dennis. Medicaid Expansion Ignores States’ Fiscal Crises. The Heritage Foundation. [Online] 01 05, 20101. [Cited: 01 21, 2011.] http://www.heritage.org/Research/Reports/2010/01/Medicaid-Expansion-Igno....

12. Rago, Joe. ObamaCare Loses in Court . The Wall Street Journal. [Online] 12 14, 2010. [Cited: 01 21, 2011.] http://online.wsj.com/article/SB1000142405274870372780457601767249562383....

Continue reading on Examiner.com: Arizona's and America's Medicaid Conundrum - Phoenix Libertarian | Examiner.com http://www.examiner.com/libertarian-in-phoenix/arizona-s-and-america-s-medicaid-conundrum#ixzz1CxW6niMs

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In all likelihood, the House will conduct their first vote on the repeal of the patient Protection and Affordable Care Act, a.k.a. ObamaCare on Wednesday. The attempt to repeal ObamaCare comes on the heels of a newly elected 112th Congress set forth to embrace the constitutional limits of government.

Authority and constitutionalism
Much of the debate surrounding ObamaCare and its repeal stem around the question of whether or not the Obama administration possesses the constitutional right to impose a mandate to purchase health insurance products on the people. On September 9th, 2009, President Obama stated the following before Congress; “[U]nder my plan, individuals will be required to carry basic health insurance...” This came as a shock to many who stood by the President and his prior claims nationalized health care would not be implemented with a mandate. However, the lesser discussed aspect of the mandate is in “authority.”(1)

"By what authority is the government enacting this law?" Associate Justice Clarence Thomas of the United States Supreme Court, rhetorically asked Matthew Clemete of FreedomWorks when discussing the constitutionality of health care reform.(1) This is a concept of constitutionalism that coincides with not only the direction of the newly elected Republican House, but epitomizes why the new House was elected. The 112th Congress started with a ceremonial reading of the U.S. Constitution, an event which was criticized as “ritualistic” and meaningless.(2) Jumping to conclusions and judging Congress’ first ever opening session with a constitutional reading forced the overlooking of what was to follow. It is the intent of the new Congress to restore constitutional limits on government. This led to a new House rule (Rule XII) requiring each new piece of legislation to clearly state its constitutional authority. Representative Eric Cantor (R-VA), then read the constitutional authority of the poorly named H.R.2, “Repealing the Job Killing Health Care Law Act.”(3),(1)

Failing Medicaid burdens the state
While the constitutional authority of health care reform's mandate is a point of contention, the impact of ObamaCare on Medicaid is driving both states and individual voters to support the demise of the program. ObamaCare seeks to extend Medicaid benefits to those under 133 percent of the federal poverty level.(4) This financial burden, though through federal law, has been forced upon the individual states. The Medicaid expansion comes at a time when states are being forced to make cuts to Medicaid in order to allow for budget shortfalls.(5),(6),(7) On January 14th, Arizona has proposed to drop Medicaid coverage for some 280,000 residents in an attempt to save $540 million.(8) It was this expansion of Medicaid that the Obama administration boasted as being able to provide coverage for all uninsured Americans. Obamacare actually falls far short of its highly touted goal. According to the Congressional Budget Office, 23 million, including illegal residents will remain uncovered when Obamacare is to be fully implemented in 2019.(4)

As Medicaid expands while receiving budget cuts, fewer and fewer physicians will accept Medicaid coverage resulting in an even great backlog in the system already plague by high Medicaid Emergency Room visit rates. The coupling of these effects has resulted in 27 states suing the federal government to block ObamaCare.(9),(10)

Health care reform's losing battle
Virginia has won the first of its suits against ObamaCare as a federal judge ruled the program was indeed unconstitutional.(11) This will most assuredly land before the Supreme Court of the United States and have a line of more than 50% of the states in the nation waiting in the balance for their cases to be heard. As the debate of the constitutionalism associated with Obamacare unfolds, much is left to be desired about elements of the program that are far more directly impacting on Americans without coverage who are being forced into Medicaid through states who may not have the solvency in which to adequately provide it. In 2010, 28 states were forced to cut Medicaid.(12) Despite the full knowledge of the failing program, forced growth of Medicare is being insisted upon under the new health care law.

Further complicating ObamaCare is the likely increase of premiums for young adults whose premiums could surge some 17 percent. An analysis of the plan conducted for the Associated Press revealed the program will burden young adults in their 20’s and early 30’s struggling to start and advance their careers in times with the highest unemployment rates in the last 26 years. This is due to the law’s design to rely on the risk pool of young adults who inevitably foot the bill for larger pools of higher risk beneficiaries.(13)

When we look at why most Americans support the repeal of the health care law it makes sense as to why they would.(14) It also goes to reason why states would go to such extent to protect both their citizenry and solvency from ObamaCare. As the repeal of health care reform begins to unfold, it will lead to spirited debate. The Obama administration has stated that the President will simply veto a repeal of health care reform should it reach his desk, while many Democrats claim a full repeal will never make it through the Senate.

Civility and humanity
Whether a supporter of health care reform or not, what is most important with the 112th Congress is that the American people hold them to task when it comes to maintaining the U.S. Constitution.(15) The constitution grants voice unto We the People and using that voice should always be tempered with civility and a sense of humanity.


1. Clemente, Matthew. The Constitutionality of Obama's mandate: Reading the Constitution (2 of 8). Freedom Works. [Online] 01 13, 2011. [Cited: 01 17, 2011.] http://www.freedomworks.org/blog/mclemente/the-constitutionality-of-obamas-mandate-reading-th.

2. Rice, Suzi. 112th CONGRESS OPENS BY READING U.S. CONSTITUTION AND THE LEFT FREAKS-OUT AGAIN. Suzi Rice. [Online] 01 11, 2011. [Cited: 01 17, 2011.] http://suzyrice.com/2011/01/112th-congress-opens-by-reading-u-s-constitution-and-the-left-freaks-out-again/.

3. Cantor, Eric Rep (R-VA). To repeal the job-killing health care law and health care-related provisions. H.R.2, 112th Congress, 1st Session. [Online] 01 05, 2011. [Cited: 01 17, 2011.] http://www.gpo.gov/fdsys/pkg/BILLS-112hr2ih/pdf/BILLS-112hr2ih.pdf.

4. Nix, Katheryn. Obamacare: Impact on the Uninsured. Heritage Foundation. [Online] 04 20, 2010. [Cited: 01 16, 2011.] http://www.heritage.org/Research/Reports/2010/04/ObamaCare-Impact-on-the-Uninsured.

5. Smith, Dennis. Medicaid Expansion Ignores States’ Fiscal Crises. Heritage Foundation. [Online] 01 05, 2010. [Cited: 01 16, 2011.] http://www.heritage.org/Research/Reports/2010/01/Medicaid-Expansion-Ignores-States-Fiscal-Crises.

6. Blase, Brian. States Cry to Washington: Remove Obamacare’s Medicaid Handcuffs. The Foundry. [Online] 01 11, 2011. [Cited: 01 16, 2011.] States Cry to Washington: Remove Obamacare’s Medicaid Handcuffs.

7. Sack Kevin and Pear, Robert. States Consider Medicaid Cuts as Use Grows. New York Times. [Online] 02 18, 2010. [Cited: 01 16, 2011.] http://www.nytimes.com/2010/02/19/us/politics/19medicaid.html.

8. Davenport, Dan. Brewer proposes cut in Medicaid enrollment. AZ Central. [Online] 01 14, 2011. [Cited: 01 16, 2011.] http://www.azcentral.com/news/election/azelections/articles/2011/01/14/20110114arizona-budget-brewer-cuts-to-medicaid.html.

9. Stephen R. Pitts, M.D., M.P.H., F.A.C.E.P., et al. National Health Statistics Reports. U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES, Centers for Disease Control and Prevention National Center for Health Statistics. [Online] 08 06, 2008. [Cited: 01 16, 2011.] http://www.cdc.gov/nchs/data/nhsr/nhsr007.pdf.

10. The Foundry. List of 27 States Suing Over Obamacare. The Foundry. [Online] 01 17, 2011. [Cited: 01 17, 2011.] http://blog.heritage.org/2011/01/17/list-of-states-suing-over-obamacare/.

11. Rago, Joe. ObamaCare Loses in Court, A victory for liberty and the Constitution in Virginia. The Wall Street Juournal. [Online] 12 14, 2010. [Cited: 01 06, 2010.] http://online.wsj.com/article/SB10001424052748703727804576017672495623838.html.

12. Smith, Dennis. Medicaid Expansion Ignores States’ Fiscal Crises. Heritage Foundation. [Online] 01 05, 2010. [Cited: 01 17, 2011.] http://www.heritage.org/Research/Reports/2010/01/Medicaid-Expansion-Ignores-States-Fiscal-Crises.

13. Johnson, Carla. Health Premiums Could Rise 17 Pct for Young Adults. ABC News. [Online] 03 29, 2010. [Cited: 01 16, 2011.] http://abcnews.go.com/Health/wireStory?id=10233582.

14. Rasmussen Reports. Most Still Favor Repeal of Health Care Law, Say It Will Increase Deficit. Rasmussen Reports. [Online] 01 17, 2011. [Cited: 01 17, 2011.] http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/health_care_law.

15. Johnson, Paul. Rhetoric Versus Virtue and Values;112th's Repeal Attempt. Conservative Voice. [Online] 01 05, 2011. [Cited: 01 16, 2011.] http://conservativevoice.weebly.com/1/post/2011/01/rhetoric-versus-virtue-and-values112ths-repeal-attempt.html.

Published 18 January 2011 on Suite101: The Repeal of Health Care Reform http://www.suite101.com/content/the-repeal-of-health-care-reform-a334774#ixzz1BWf7v7aQ