Cost-shifting will only continue under Obamacare

Some state officials say Oklahoma would “save” about $47.8 million a year if the state accepts the Obamacare-driven expansion of Medicaid. That would shift to the federal government part of the current cost of treating those with mental health problems. Currently, the state pays for treatment through the Department of Mental Health and Substance Abuse Services, the Department of Corrections and the state Health Department.

Of course, those savings are all on paper. Oklahomans pay state and federal taxes. Shifting the cost from one side of the ledger sheet to the other doesn't make any difference for those paying taxes into both columns.

Put another way, if you siphon gas out of your car and into your truck, you aren't saving money on truck fuel. You're just refueling your car more often. The fact that Obamacare supporters tout the government-finance version of a siphon hose as a major policy achievement shows just how flawed this law is.

At the same time, state officials may start pushing back on the federal government's cost-shifting to states.

Stateline.org reports that the Supreme Court's ruling on Obamacare, which made the Medicaid expansion voluntary, may impact other state-federal programs that could be seen as coercive. The court said the Medicaid expansion's immense cost and significant program changes made that portion of the law coercive. It said states could opt out of expansion without losing existing federal Medicaid dollars. Many federal education programs have similar characteristics and some question if those programs could survive legal challenges if enacted today.