Fact Check Obamacare facts lost among rhetoric

Thom Hartmann, who hosts a show called The Big Picture, was discussing the decision of lawmakers in 25 states not to expand Medicaid coverage as envisioned by the Affordable Care Act. He said the decision was motivated by politics (most of the states that opted out of the expansion are run by Republicans), and that it hurts state taxpayers.

Hartmann said, "When Rick Perry says to the people of Texas that he's not going to accept money from the federal government to pay for the expansion of Medicaid, what he's really saying, to his own people, the people of Texas, 'Naw, you can't have your own tax dollars back.'"

Medicaid is a federal-state partnership to provide health care primarily to poorer Americans.

The program is managed by states but funded through a combination of federal and state dollars. Who pays what varies, but generally the federal government contributes more than the states. While the health care law does not change the funding structure for people already enrolled or eligible to enroll in Medicaid, it does offer states a deal in exchange for adding new people to the system.

For new enrollees, the federal government would pay 100 percent of the costs for three years. (States would have to pay for some administrative costs.) After that, states would be asked to pay some costs, but never more than 10 percent.

Hartmann's statement is most accurate for the first three years of the program when the federal government pays 100 percent of the cost of care for newly enrolled people. Beyond that point, the results could vary. There is a body of studies that point to gains for the states, but a range of outcomes is possible.

politifact.com and factcheck.org

Chip Tuthill, Mancos