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Fact or fiction? Reform adds to states' burden

Claim: State Medicaid programs are being cut even as Congress plans a big Medicaid expansion.

Medicaid, which provides medical insurance to low-income Americans, is funded jointly by the states and the federal government. Wealthier states bear a bigger share of their Medicaid costs than poorer states do. State eligibility rule vary, but certain people, such as low-income pregnant women and children, are eligible in all states. In several states, adult eligibility is now set at less than 100 percent of the federal poverty line, which is $22,050 for a family of four. The number of people enrolled in Medicaid, 42.6 million last year, has soared since then, due to the recession. The Recovery Act gave the states a windfall of $30 billion to help them pay for Medicaid, but the insurance overhaul bill would put new burdens on state taxpayers.

Fact or fiction?
Fact. The House overhaul would require states to increase eligibility to 150 percent of the poverty level. Enrollment would grow by 15 million people, or more than a third, costing $460 billion over 10 years. The federal government would pay the full cost of care for the newly eligible in 2013 and 2014. The federal share would drop to 91 percent in 2015 and states would pay 9 percent of the costs for the new enrollees. But states can't even afford the current Medicaid program. Due to the drop in state revenues, legislatures from Rhode Island to California have been forced to cut Medicaid spending. Tennessee Gov. Phil Bredesen, a Democrat, said Medicaid expansion would force his state to take $735 million from schools, state pensions, and other programs. If Congress wants to redesign insurance, he said, "More power to them, but I think they should pay the bill."

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