In a recent speech to several hundred legislators and state health officers, Secretary Sebelius categorically asserted “this is not a bait-and-switch.” She was referring to the federal government’s commitment to funding 90% of the Medicaid expansion in perpetuity. There is widespread fear among the states that Uncle Sam will renege on this promise, leaving them holding the bag for whatever amounts federal policymakers decide can no longer be afforded. As a former Kansas legislator, insurance commissioner and governor, Secretary Sebelius presumably knows that she cannot bind the hands of a future Congress—either constitutionally, legally or even morally. The members of such a Congress are quite free to make their own determination of whether their counterparts in 2010 (all Democrats as it turns out) made a reckless and foolish promise that wholly lacked credibility in light of the country’s $230 trillion in debts and unfunded liabilities at the time of passage[1] and quite free to unburden future generations from that obligation if they so desire.
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