Obamacaid -- Review & Outlook, The Wall Street Journal

Democrats ask: Why not expand the worst insurance in America? 

ObamaCare's website appears to have been built by Mitt Romney's "Project Orca" digital team, and perhaps tens of people have managed to sign up so far. "Fully enrolled, I can't tell you. I don't know," Health and Human Services Secretary Kathleen Sebelius conceded Monday. But Democrats do have one lament about implementation: Some states are opting out of the Medicaid expansion.

Medicaid, the joint state-federal safety net intended for the poor, already covers more than one of five Americans and pays for two of five U.S. births. And that's before ObamaCare dumps up to 20 million new dependents onto its rolls. Liberals are still somehow evoking Little Nell and the blacking factory because 26 Governors or legislatures or both are so far declining to expand. Their hysterics would benefit from a fact or two.

First note the Perils-of-Pauline Medicaid moment is the result of a 7-2 Supreme Court majority, which ruled that the Affordable Care Act's expansion mandate was coercion exceeding the Constitution's limits on federal spending powers. This was the first such holding in the history of the Republic and the rebuke ought to embarrass Democrats, if they're still familiar with that sensation.

Note also that the opinion, which allowed states to choose to expand or not, was joined by Justices Stephen Breyer and Elena Kagan, President Obama's former Solicitor General. These liberal stalwarts explained that ObamaCare transformed Medicaid into something that "is no longer a program to care for the neediest among us." The major reason states don't want to participate is that rather than help members of society emerge from poverty, new Medicaid is supposed to be a permanent Washington-run, price-controlled health system, with no flexibility for the states.

The feds are dangling the promise of paying for all the costs of the new beneficiaries, at least for the next three years. This subsidy honeypot can't last forever, and Governors are right to worry about taking on fiscal obligations that will increase 13% on average in 2014 under new Medicaid, according to a Kaiser Family Foundation state budget survey.

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