On Monday, the Feds said, “NO!” to partial participation for states in the federal Medicaid plan. Now the states will need to decide to expand Medicaid per Obamacare (“go all in”) or not (“fold”).

For the past few months, we have heard governor-elect Pat McCrory state that he was interested, as were most Republican governors, in a partial participation in the  federal expansion of Medicaid.  Meaning, the states would expand Medicaid, but not quite as much as Obamacare requires. Well, this is no longer an option.

Monday, Secretary of Health and Human Services Kathleen Sebelius, authored a memo that stated “the law does not provide for a phased-in or partial expansion.”  Sebelius reiterated Obama’s claims that the federal government will handle 100% of the costs of covering new enrollees in 2014, 2015 and 2016, and at least 90% in subsequent years.  However, this claim of the federal government “picking up the tab” has been under intense scrutiny.  First, no one knows where the colossal amount of money will come from, although Obama has slashed the upcoming Medicare budget by over 716 billion. Secondly, states are terrified that, once 2017 comes, the states will not be able to afford the Medicaid bill.

According to a Forbes blog, just more than a dozen states appear certain to take part in the expansion. In about 13 states, officials have been leaning heavily against it. In the remaining states, the decisions are uncertain.  The Forbes blog has NC as uncertain.  No shock there. McCrory has only stated that he wants to research the possible consequences of expansion before making a decision.  A statement, in my mind, that shows McCrory is inclined to make an educated decision, instead via party lines.  He may also have been waiting to see whether NC could have submitted a partial expansion, but now that is not an option.

The fundamental question NC state leaders have to ask is, “Do I believe that NC will continue to get 90 percent of the cost of the expansion from the federal government perpetually, given that the federal government has no money?”