The Spectacle Blog

Nelson Calls for All States to Be Treated Same on Medicaid Expansion

By on 1.7.10 | 3:05PM

Sen. Ben Nelson, under fire for the so-called "Cornhusker kickback" that helped secure his vote for the Senate health care bill, has released a statement calling on all states to be treated equally by the final health care bill. Under the bill he voted for, Medicaid would be expanded by about 15 million people, shifting billions in new costs onto the states, except Nebraska -- which would have federal taxpayers pick up 100 percent of the tab.

From his statement:

"As a former governor, I've long fought against unfunded federal mandates, which force Washington rules on states with little or no money to pay for them," said Senator Nelson. The current health care bill has an unfunded mandate for expanding Medicaid. While helping more Americans obtain health coverage is important, this mandate could burden state budgets in uncertain economic times ahead.

"I've been in serious discussions with Senate leaders and others to secure changes in the bill to treat all states equally," Nelson added. "At the end of the day, whatever Nebraska gets will apply to all states."

Among options Nelson has discussed would be for the House and Senate conference committee to change the legislation to provide full federal funding of the Medicaid costs for all states, or allow every state the ability to opt out of the expense they'll begin to pay in 2017.

"My view is: either fund it or un-mandate it," Senator Nelson said....

"My intent has been and remains absolutely clear," Nelson said. "Every state should be, and will be, treated the same."

A few quick thoughts: 1) Having federal taxpayers pick up the entire tab for the Medicaid expansion would boost the cost of the legislation. An analysis (PDF) by the Congressional Budget Office pegged the cost shifted onto the states in an earlier version of the Senate bill at $25 billion from 2010 to 2019. 2) It's unlikely liberals would agree to allow states to opt-out of the Medicaid expansion, which could substantially impact the amount of people covered by the health care bill. In the Senate bill, the Medicaid expansion accounts for nearly half of the 31 million people who will obtain coverage as a result of the legislation, according to the CBO. 3) If Nelson feels so strongly about this, it would have been much easier to get what he wanted last month, when Democrats were desperate for his cloture vote. Instead, he folded like a cheap suitcase.

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