In a way it was no surprise that whether states should expand their Medicaid programs was a primary topic of discussion during the recent meeting of the 15-state Southern Legislative Conference. What is somewhat puzzling is why the change has not already been rejected by most fiscally challenged - read "broke" - states.
Legislators at the SLC meeting in Charleston, understand the question of Medicaid expansion is one they will have to decide. Though governors can make the executive branch decision to go along with the national health care law mandate on Medicaid, legislatures will have to appropriate money for it.
Many governors, including Earl Ray Tomblin are considering whether to add new enrollees, as required by the federal law, or hold the line on Medicaid numbers. The Supreme Court ruling earlier this summer, essentially banning President Barack Obama's administration from taking punitive action against states that refuse to expand the program, gives governors and legislators a choice.
Again, however, it is a decision loaded with ramifications for taxpayers, who in many states have seen taxes increased and services reduced in order to balance budgets.
West Virginia has been fortunate in that regard - but our luck has run out. The existing Medicaid program will cost West Virginia taxpayers about $200 million more this year than in the past. Budget surpluses our state has enjoyed for several years have been wiped out, again, by Medicaid at the current level.
So quick has been the fiscal turnaround that some are predicting a $400 million hole in the state budget for the next fiscal year. That certainly won't be helped by this week's poor revenue projections that show projected tax revenues will grow at a much lower level than in past years.
Yet the White House wants West Virginia to add about 130,000 new enrollees to Medicaid. One estimate - quite possibly low - is such growth would cost state taxpayers another $80 million a year.
Given these circumstances, the question facing legislators in our state is not whether we can afford to go along with Obama's planned expansion of Medicaid.
The answer to that is clear: Without major new taxes, we can't.
And given the financial travails through which many West Virginia residents are going, lawmakers owe it to their constituents to find out how they feel about the matter.
This is a choice that should not be left to the politicians.