“… States have developed all kinds of financing gimmicks designed to increase D.C.’s share of the funding and reduce their own.
Republicans have talked about prohibiting some or all of these gimmicks, and they have a pretty good argument
many nonpartisan analysts support: These mechanisms allow states to shirk some of their responsibility for the program. At the same time, the entire health care economy works this way—with all kinds of convoluted workarounds. Take away this one, and it’s virtually inevitable some states couldn’t or wouldn’t make up the funding.
Instead, they would cut back their Medicaid programs in one way or another, leaving more people unable to get affordable care. …”