A history ignored

"A history ignored" Continued...

While the federal government will pick up 100 percent of the tab for the first two years, that share gradually drops in successive years, bottoming out at 90 percent by 2020.

But there are also the kind of costly details you'd expect in a 3,000-page law: The new law, for example, will impose just under $12 billion in new administrative costs to the states in the program's first six years.

Worse: The big federal subsidy to the states only apples for those who are newly eligible to Medicaid, meaning states will have to foot half of the bill for those who are currently eligible for Medicaid but haven't signed up. Since individuals will be forced to carry insurance or pay a fine, many already eligible are expected to flock to join Medicaid.

In total, it is expected to cost states more than $33 billion in new Medicaid costs through 2020, predicts Heritage's Ed Haislmaier. That could wind up costing California as much as $3 billion a year.

Hints are also appearing that another part of TennCare's history may repeat itself: The Congressional Budget Office estimates that 9 million employees nationwide may lose their employer-sponsored plans and be dumped into government-paid plans.

In Tennessee, state officials are worried about a TennCare sequel. They predict Medicaid rolls will jump by more than 200,000 and cost $1.1 billion in Obamacare's first five years. That is why Tennessee Gov. Bredesen last year called congressional plans "the mother of all unfunded mandates" and why six of the nine members of Tennessee's congressional delegation voted against the final bill.

Putting any cost burden for implementing healthcare expansion on fiscally troubled states means even deeper cuts are likely in other programs. "Unlike the feds, they can't print money," Haislmaier said. In their 2010 budgets, even without the new healthcare mandate, 30 states cut education funding and 25 states reduced transportation dollars. Soon federal stimulus money, which has propped up many programs, will disappear.

The TennCare fight has shifted to controlling costs: This year the state legislature has proposed to limit hospital visits to eight a year and to limit prescriptions to five per month.

"Yes, it's rationing," admits GOP state lawmaker Hensley. "This is exactly what is going to happen on a national level in a few years."

As with TennCare, the road to federal healthcare havoc may be paved with good intentions to fix a broken system. But TennCare provides a recent case study of the fallacy of expecting more for less and of what happens when government steps in to manage care.

"It is a shame that Phil Bredesen, our Democratic governor who campaigned on fixing TennCare, did not become the Health and Human Services Secretary," lamented Rep. Roe, in a House floor speech. "What happens next is obvious to those of us who have seen this play out before."

Edward Lee Pitts
Edward Lee Pitts

Lee teaches journalism at Dordt College in Sioux Center, Iowa, and is the associate dean of the World Journalism Institute.


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