This is the Cato Daily Podcast for Monday, December 7, 2015.

I'm Caleb Brown.

The Medicaid expansion built into the Affordable Care Act threatens state budgets

and the private sector provision of health insurance.

But there are ways states can mitigate its effects.

Justin Owen is president of the Beacon Center of Tennessee.

At the State Policy Network annual meeting, we talked about what Tennessee is doing to extend the promise of affordable health care.

What were the incentives placed before states in Obamacare's Medicaid expansion?

Well, the first was mandatory expansion

until the Supreme Court ruled that the federal government couldn't

force the states to expand Medicaid.

They were going to be required to do so and massively.

Unfortunately, one silver lining of the first Obamacare lawsuit was that the Supreme Court said unless you

fund it entirely the you the federal government can't force states to

expand Medicaid. So that gave the states the option. Of course a lot of states have expanded Medicaid.

Predominantly Democratic states, though several Republican governors have

also expanded Medicaid, many have done so unilaterally because in some cases they can do

so without legislative approval in Tennessee that's a little different because of what our

legislature did after the Supreme Court ruling, but

before our governor proposed the Medicaid expansion to take some ownership of that decision

and take some of the power away from the governor.

In Kentucky, my home state, Steve Bashir essentially created the Medicaid expansion

...