Greg Sargent usefully points to a 2011 Urban Institute study showing that initial estimates of state costs associated with ACA’s Medicaid expansion don’t take into account a variety of state savings (mainly from existing beneficiaries being shifted into higher-federal-match categories of the program, and also from new Medicaid eligibility for mental health patients now receiving purely state assistance) that could actually make the overall package a fiscal plus.
This data will provide valuable ammunition to those fighting efforts by GOP governors and legislators to opt out of the expansion. But I wouldn’t assume it’s any sort of game-changer. You can expect the Jindals and Haleys and Perrys to ignore or dismiss such estimates as biased or unreliable, just as Republicans have almost universally scoffed at the CBO estimates “scoring” ACA as a federal deficit reducer. Another problem is that Republican pols typically claim that the existing Medicaid program as fiscally unsustainable, so they won’t accept it as a baseline for what is tolerable in the future.
But more importantly, we have to remember that this is an ideological and even a moral issue to conservatives, who view dependence on any form of public assistance as eroding the “moral fiber” of the poor (as Paul Ryan likes to put it), and as corrupting the country through empowerment of big government as a redistributor of wealth from virtuous taxpayers to parasites who will perpetually vote themselves more of other people’s money. This line of “reasoning,” of course, would justify the abolition of Medicaid, not just a failure to expand it, but conservatives are careful (and smart) to disguise that ultimate goal and simply suggest we have reached some sort of welfare-state tipping point beyond which we become Greece.