Since mid-summer, Gov. Earl Ray Tomblin has been trying to find out just what it is that "Obamacare," the national health care law, requires our state to do. Tomblin is not alone; officials in many other states want answers, too.
They have not been forthcoming from U.S. Health and Human Services Secretary Kathleen Sebelius. There are two possibilities for her silence:
1. She doesn't know.
2. She and her boss, President Barack Obama, are waiting until after the election to drop the boom on West Virginia, Ohio and other states where taxpayers simply can't afford to pay for more entitlements.
One of the key requirements in Obamacare is that states vastly increase the number of people eligible for Medicaid. Here in West Virginia, that could cost the state as much as $200 million more a year. That would be on top of spending for the current Medicaid program that has chewed a huge hole in the state's budget.
Merely to pay bills for Medicaid as it is will require 7.5 percent spending cuts in many state programs, Tomblin has estimated. To his credit, he's already told agency heads to plan for that.
This summer, the U.S. Supreme Court upheld the Medicaid expansion facet of Obamacare - but struck down Washington's ability to, in effect, fine states that refuse to go along with it. Still, the requirement is in the law and officials in all 50 states have to decide whether to comply with it.
State officials want answers on a variety of Obamacare-related questions. But Sebelius has not provided any guidance that would help Tomblin and legislators decide what we must do and what types of penalties other than the financial ones rejected by the high court might be employed by the Obama administration if we say West Virginia simply cannot afford full compliance.
My guess is Sebelius and Obama know very well how they're going to respond to the governors - and will tell them a few days after the Nov. 6 election. And it wouldn't surprise me if the White House takes a hard, expensive line with the states: Do it or else we'll make your states' lives miserable in any number of ways.
Tomblin already has said he'd like to help low-income West Virginians who want Medicaid coverage - but won't do anything the state can't afford. There's a way to lessen the gap between what we want and what we can afford, if Obama and Sebelius will allow it.
When U.S. Sen. Joe Manchin, D-W.Va., was in town the other day, I reminded him of the Mountain Health Choices program his administration established when he was governor. He smiled, somewhat ruefully.
That was because Mountain Health Choices was a great idea to curb Medicaid spending and improve the health of people on the program - but it was shot down after federal officials and in-state liberals complained it was somehow unfair.
Mountain Health Choices was a program for which Medicaid recipients could sign up, but were not required to follow. In exchange for their agreement to abide by MHC rules, clients received enhanced Medicaid benefits.
The rules boiled down to choosing a family doctor, doing what he or she recommended, keeping health care appointments and not using emergency rooms or clinics for non-emergency situations. Manchin believed, with good reason, that it would improve the lives of many Medicaid recipients and, by making them healthier, would reduce costs for the program.
Again, however, it was scrapped - leading, in part, to the higher Medicaid costs we're now having trouble financing.
A national-scale program like MHC could make it easier for states to cover more people under Medicaid. But will Sebelius and Obama allow it?
For now, they aren't saying. Unfortunately, that probably means the answer is no.