As the lawsuits challenging the Affordable Care Act worked their way up to the Supreme Court, I always found the challenge to the expansion of Medicaid to be the strangest part. Quick context: the program provides insurance for poor people, splitting the cost between the federal government and the states. But the current rules say that each state gets to set its own eligibility standards, which meant that if you live in a state run by Democrats and you're poor, you can get Medicaid, but if you live in a state run by Republicans, you have to be desperately poor to get Medicaid. For instance, in Mississippi, a family of four has to have a yearly gross income below a princely $9,828 to qualify. Because if a family is living high on the hog with their $10,000 a year, they aren't really poor, right?
Fortunately, the Affordable Care Act fixed this, by changing Medicaid so that everyone with up to 133 percent of the federal poverty level ($30,657 for a family of four) would qualify. And to make things easier on the states, the bill provided that the federal government would pick up almost all of the tab. The federal government pays 100 percent of the cost of paying for the new enrollees through 2016, 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and 90 percent from then on. In other words, the federal government is saying to states, "Here's a bunch of free money to insure a whole lot of your citizens, which will make them healthier and more productive." And almost every state run by Republicans replied, "How dare you do such a thing to us! It's unconstitutional! We're suing!"