By CARLA K. JOHNSON

CHICAGO - As the dust settles from the U.S. Supreme Court's momentous decision on health care, top state leaders have faced off with conflicting figures about the cost to Illinois of expanded Medicaid coverage. President Barack Obama's health care overhaul expands Medicaid to more Americans, but the court's ruling, in effect, makes the expansion optional for states.

The day of the court's decision, Illinois Comptroller Judy Baar Topinka, a Republican, warned that the state would pay "an additional $2.4 billion" over six years. She urged lawmakers "to start saving now for those added costs."

U.S. Sen. Dick Durbin, a Democrat, countered that the federal government would pay "the entire cost" of the expansion. "I want to send to Miss Topinka, who is a friend of mine, a copy of the bill," Durbin told one TV news station, implying that Topinka would back down once she had read the law.

Who's right? As it turns out, they've both got facts on their side. But both fail to mention critical information.

Voters are likely to hear more sound bites from politicians about the cost of expanding Medicaid for states from now until November's presidential election. Governors in at least five states have said they'll reject the Medicaid expansion now that it's optional, citing costs.

Illinois Gov. Pat Quinn has embraced the president's health care law, including the Medicaid expansion. Quinn's office says cost estimates have been incorrect and "unduly high."

Here's the reality: Most of the cost of expanding Medicaid program will be paid by the federal government, but states will pay some additional costs primarily because of a quirk called "the woodwork effect."

State and federal governments share the cost of Medicaid. In Illinois, the split is about 50-50. Health policy people talk about the "federal Medicaid match" because the federal dollars roughly match the state dollars. The formula varies from state to state.

Under the new health law, as Durbin suggests, the federal government will pay the entire cost - 100 percent - for people newly eligible for Medicaid for the first three years, starting in 2014. The federal share falls to 90 percent by 2020.

View post:

Health care law's costs complicated