If you want to know what's going on, you need to start by reading my wife's "50 Flowers" paper. Ann Marie Marciarille:
Let Fifty Flowers Bloom: Health Care Federalism after National Federation of Independent Business V. Sebelius by Ann Marie Marciarille :: SSRN: Conventional wisdom is that the American public does not want to think too long or too hard about Medicaid. Medicaid’s reputation has long been big, complicated, and widely misunderstood…. Medicaid is the budget-buster of government funded health insurance. Its budget busting propensities are most pronounced at the intersection of Medicaid and the government-funded health insurance program we do love to discuss: Medicare…. [E]verything possible will happen: if somebody can imagine it, some state will try it. This paper first looks at the pre-ACA past… considers the past role of Medicaid… and how the Supreme Court has understood that role. It next considers the roles that Medicaid is likely to play in our health care system post-implementation of the Medicaid opt-in in 2014…. It finally considers the implications of transformed health care federalism for the implementation of the ACA….
The ACA’s individual mandate is Constitutional, as is the Medicaid expansion, in large part. The states have been re-enforced in their historic roles as Medicaid makers or experimenters. A close reading of the statute and the NFIB opinion with an understanding of the background of health care markets is in order to provide a counterweight to the tendency of Americans to use the ACA as 'something of a blank slate onto which Americans … [impose] their own hopes, fear and concerns.'
And N.C. Aizenman:
GOP governors seek leeway on Medicaid expansion: In a letter to Obama, Republican governors asked for a meeting “as soon as possible” to negotiate for greater control over their Medicaid programs…. “To make any health care reform truly successful, [the administration] should let states do what they do best — innovate and tailor solutions to the needs of their citizens,” the governors wrote. The letter was signed by Jan Brewer of Arizona, Bobby Jindal of Louisiana, Rick Scott of Florida, Robert F. McDonnell of Virginia and the governors of Iowa, Maine, Mississippi, Ohio, South Dakota, Utah and Wyoming….
In June, the Supreme Court ruled that the federal government cannot penalize states for refusing to go along with the full Medicaid expansion called for in the law as of 2014. Since then, state officials have floated the idea of partly expanding Medicaid. But legal scholars sharply disagree over whether Obama administration officials have the legal power to authorize partial expansions….
Under the law, the federal government would pay the full amount of covering the newly eligible recipients for three years. The federal match would phase down to 90 percent by 2020. But that’s still much higher than the regular federal match rate for Medicaid, which varies from 50 percent to 78 percent. The governors pushing for a more modest approach want to get the enhanced federal match for a partial expansion — covering people with incomes of up to, say, only 100 percent of the poverty line….
