West Virginia Gov. Earl Ray Tomblin's recommendation to expand the state's Medicaid program probably represents a political point of no return. Once an entitlement is established, it is here to stay.
Tomblin said Thursday that, after many months of study and examination by consultants, he has decided the state should bow to a federal demand that more people be added to the Medicaid program. No doubt the Legislature will go along with the governor.
Expansion will add about 91,500 more people to a system that already serves about 350,000 low-income and disabled Mountain State residents.
West Virginia is struggling to pay its share of the existing Medicaid program, however. Because of Medicaid, Tomblin and legislators have cut spending in other areas of the budget to keep it in balance.
At first glance, the deal offered by the federal government to expand Medicaid seems irresistible. According to a consultant hired to evaluate the prospect for West Virginia, adding all those new Medicaid clients would cost the state just $5 million a year for the first three years. By 2020, the state share would increase to $65 million a year.
During the first decade of an expanded program, federal funds would cover $5.2 billion of the cost, with the state chipping in $375.5 million, according to the consultant.
Sounds almost too good to be true, doesn't it? That's the catch: Down through the years, thoughtful local and state officials have learned that when Uncle Sam makes a too-good-to-be-true offer, the clock already is running toward the time when someone in Washington decides federal funding needs to be cut back. Then municipalities, counties and states are left holding the bag.
"We must carefully watch federal efforts," Tomblin warned in a press release about his decision. "If the program becomes unsustainable, particularly after three years, or the federal government changes its promised funding allocations, we must be prepared to take action to protect our state," he explained.
The governor's clear implication is that if Washington goes back on its pledges, West Virginia will have no choice but to go back on its Medicaid expansion, too.
But that is not how things work in politics. In, say, six years, will the governor and legislators then want to lose the votes they surely would forfeit by telling 91,500 people they no longer will receive Medicaid benefits? Get real. It won't happen.
It appears the die has been cast, however. And that is an appropriate way to look at it - for state officials are taking an enormous gamble.