While Obama has been at great pains to make a show of avoiding taxes on the middle class to pay for his health care changes, his proposed increase in Medicaid eligibility will have a huge impact on the 39 states whose income cutoffs for the program are below those required in the new federal legislation.
All states except for Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Jersey, New York, Rhode Island, Tennessee, Vermont and Wisconsin (plus the District of Colombia) will have to raise their eligibility for Medicaid under the Senate health care bill. And they will have to pay for part of the cost. Under the House bill, with a higher Medicaid eligibility standard, Massachusetts and Vermont would also have to pay more.
The magnitude of the new Medicaid spending required by Obamacare is such as to transform the nature of state finances. A large part of the reason that some states, particularly in the South, have been able to avoid higher taxes is because they have chosen to keep down the Medicaid eligibility level.
The hardest hit states would be Texas ($2.8 billion in extra state spending), Pennsylvania ($1.5 billion), California ($1.4 billion) and Florida ($909 million). Who knows if Florida could avoid imposing an income tax if it has to meet so high an unfunded mandate?
In many of the states represented by swing senators in the health care debate, the required increases in state spending are likely to be quite high. In Arkansas, where swing Sens. Mark Pryor and Blanche Lincoln live, the increased state spending required under the Obamacare bill would come to $402 million (not counting the federal share), about a 10 percent increase in state spending. In Louisiana, where Marie Landrieu has sold her vote in return for more Medicaid funding, the increase would come to $432 million (a 5 percent hike in state spending), more than wiping out the extra funds she got in return for her vote. In Indiana, where moderate Evan Bayh is senator, spending would go up by $586 million, a hike of 4 percent. In Ben Nelson's Nebraska, the additional state spending required under the bill would be $81 million, a 2 percent increase. The Obamacare bill would cost North Dakota, home of Sens. Kent Conrad and Byron Dorgan, $14 million, and in South Dakota, represented by moderate Democrat Tim Johnson, Medicaid spending would have to rise by $33 million.