Sequestration Might Be Least Bad Outcome for Healthcare

Even outside of stark political differences over the law, it's easy to understand why states may be wary.

Jack Ebeler, one of the panelists and a former vice chairman of the Medicare Payment Advisory Commission as well as one of the architects of the new law as a member of the staff of the House Committee on Energy and Commerce, believes states are likely to sign on to the expansion slowly, as they did when Medicaid was first created in 1966.

"In January of 1966, when Medicaid was introduced, only six states signed on," he said. "There were 27 states next year, then nine more, and eventually every state signed on to the Medicaid and S-CHIP (State Children's Health Insurance Program)."

Of course, he admitted in response to a question that it's theoretically possible that states would be able to take advantage of the first three years of "free money," and then decide to get out of the expansion.

Given the difficulty governments have with removing an entitlement program once it's established, however, that would seem to be a dubious strategy.