Medicaid expansion

The Medicaid expansion is part of the broader case brought by opponents of Democrats’ 2010 health-care law that the Supreme Court will begin hearing March 26. To reduce the number of uninsured Americans, the law calls for adding 17 million or more additional people to the Medicaid program in the next decade.

While the case before the court centers on the law’s requirement that most Americans carry insurance or pay a fee, plaintiffs also are arguing that the Medicaid expansion also violates the Constitution. The plaintiffs, who include attorneys general and governors from 26 states, contend the federal government is forcing them to take on expensive new responsibilities that they can’t afford.

Supporters of the health-care law point out that the federal government will pick up 100% of the costs of the Medicaid expansion for the first few years after 2014, and 90% after that. They also say states are free to leave the program if they choose, and that states can’t take federal money for Medicaid and ignore rules for how it can be spent.

Opponents of the law say that, with increasing pressure on state budgets, of which Medicaid is usually the largest share, even that 10% contribution could be too much to bear. They say states can’t truly exit from the program entirely because they have come to depend on it.