Florida Governor Rick Scott’s announcement that he will expand the Sunshine State’s Medicaid program this week confirms what AEI scholar Michael Greve has long declared: America has a federalism problem—one that cannot be solved, as many conservatives insist, by simply delegating more power to the states.
If approved by the state legislature, the Medicaid expansion would cover uninsured Floridians earning up to 138% of the poverty threshold and add more than one million residents to the state’s Medicaid rolls. Sounds pretty costly, especially for a state that already spends $21 billion—30% of its annual budget—on Medicaid. But Gov. Scott justified his decision insofar as the federal government will shoulder 100% of the costs associated with the expansion through 2017. After that, Washington will front 90% of the costs until 2023.
Of course, Gov. Scott wouldn’t want to “lose” federal dollars that are now on the table, a key component to the Affordable Care Act that expands coverage among uninsured Americans. And the costs that Florida will shoulder from this expansion are comparatively small. The ten year price tag for Tallahassee is a little north of $5 billion. Meanwhile, taxpayers nationwide are on the hook for $66 billion. And that’s for Florida’s expansion alone. All told, the Medicaid expansion nationwide will cost American taxpayers $638 billion over the next decade, according to the Congressional Budget Office.
Enter Greve, who presciently identifies the pathologies inherent to contemporary federalism in his February 2012 book, The Upside Down Constitution and—even further back—in a speech to Boise State University in October 2011. Contemporary federalism, according to Greve, has been inverted, allowing states to impose their will on the entire nation. Decisions in Tallahassee now affect citizens in Toledo—citizens who have no recourse through the ballot box.
If you must, you can bypass Greve’s magnum opus by reading his Boise State speech, in which he acknowledges that state power “has been unleashed in domains where its exercise poses monumental dangers to the rest of the country—control over the commerce of the United States, expensive social experiments on our collective federal taxes, wild gambles on federal dollars.”
Collusion has replaced competition between the states and federal government. We’re worse off for it.