It will take weeks, perhaps months, to determine all the ramifications of the Supreme Court ruling upholding much of the national health care law. One change ordered by the court is clear, however: States may not have to expand their Medicaid programs as much as had been thought.
Part of the high court's ruling concerns the federal mandate that Medicaid health insurance be offered to anyone with household income below 133 percent of the official federal poverty level. Justices ruled Washington cannot enforce that demand by withholding federal Medicaid money from states that refuse to comply.
Obeying the rule could add as many as 140,000 people to Medicaid rolls in West Virginia, and nearly 700,000 in Ohio. Though Medicaid costs are shared by states and the federal government, the additional direct cost to West Virginians could be in the $200 million range annually. In Ohio, the tab could surpass $1.1 billion a year.
Neither state can afford that level of new spending without tax increases in some form. Ohioans have just battled through a painful round of state spending cuts to keep the budget in balance.
In West Virginia, costs for the existing Medicaid program, without any additions, have increased by about $200 million a year.
While the nation's highest court has ruled federal officials cannot threaten to cut off money states use to help low-income residents in order to force them to assist more people, it is unclear what other forms of pressure can be used to force compliance with all the health care law's requirements.
For now, however, it seems the states may have options.
In both West Virginia and Ohio, those options need to be clarified. Then, state officials need to decide how to proceed - whether to expand Medicaid to the point demanded by the law, to increase it somewhat, or to leave it alone. Debate over how to proceed should begin as soon as possible. It should be based on a reality residents and officials of our states, if not all those in Washington, understand-that we cannot always afford to spend as much as we would like.