Sara Rosenbaum and Timothy Westmoreland argue that the CBO and JCT incorrectly interpreted the Supreme Court’s ruling on the Medicaid expansion. That interpretation is an extremely important issue. Provided the GOP doesn’t sweep in November, it may be the most important health policy issue in the next few years, though there will be plenty of other big ones too.
The new CBO/JCT analysis seems to assume that states may also choose a middle ground of only partially implementing the ACA’s Medicaid expansion. [However], there is nothing in the Court’s ruling or the text of the ACA that allows states to partially implement the expansion on their own or allows the Secretary of Health and Human Services to give states this flexibility outside the limitations of a formal demonstration program.
As I noted earlier this week, and Rosenbaum and Westmoreland do in their post as well, demonstrations under the new Medicaid waiver rules have less wiggle room than previously. In short, it is not so clear that states can do or the Secretary can approve what the CBO and JCT presume. I encourage you to read the full piece.