Today, as we know, the Supreme Court upheld Obamacare, with one major caveat. The individual mandate was upheld on the basis that it is a tax; however, states cannot be forced to increase its Medicaid funding to pay for the throngs of individuals who will be seeking care under the increased income limits.
Thus, anyone who meets certain income eligibility levels will be required to purchase their own health insurance. Those whose income is below that level will be eligible for Medicaid if a state takes part in the program. The federal government will pick up some share of the increased Medicaid costs, but each state will be expected to cover the rest. The part of the law that was struck down mandated states that if they chose not to pick it up, they would lose all of the Medicaid funding. So now, states may retain its previous level of Medicaid funding and will not be responsible for any of these new people..
Now we get into the unintended consequences of this decision. I’d predict that states in this region (the Deep South) of the nation will never increase their own Medicaid funding if not mandated to do so. Currently, some parts of Medicaid are mandatory for states that take part in the program (all of them) and some parts are optional. So, for example, adult dental care is not part of the Medicaid package in most of the states down here. But in many other states, this is part of the program.
Also, these states have a much higher percentage of the population down here living in near poverty than in most other states. These are the people generally who will be left out of the ‘universal’ health care coverage. So, the states that are the poorest and have the highest percentage of people who need health care are the states that will not be part of the program. No matter what the rest of the country does, 25% of the population will not be part of this. Once the Medicaid mandate was struck down, any employer based program, which Obamacare is, can never be workable nationally.