Expand Medicaid and Expand Federal Power? Vaccine Mandates Are a Cautionary Tale

By Matthew Nicaud
January 17, 2022

In recent years there has been an increasing call to expand Medicaid in the state of Mississippi, with assurances of “free money” and a boost to the state economy. Despite such rosy pictures, recent events have demonstrated the danger of inviting an increasingly hostile federal government with open arms.

In November 2021, the Centers for Medicare & Medicaid Services (CMS) issued a rule that required staff members of the facilities that participate in Medicaid or Medicare to be vaccinated, with limited religious and medical exceptions. While the mandate was challenged in court, an opinion issued on January 13th, 2022, the United States Supreme Court ruled that the facilities must comply with the CMS vaccine order to continue to receive CMS funding, with the reasoning that Congress had already granted CMS such authority.

The legal doctrines surrounding the challenge to the mandate are outside the scope of this article. But ultimately, the bottom line is that the Mississippi nurses and doctors who have served on the front lines of the pandemic for months will now be subject to the whims of Washington. Instead of making personal choices regarding vaccinations, those in the hospital system have had the decision made for them by federal bureaucrats.

Granted, most of those in the hospital system are already vaccinated. However, the hospital system across the nation is already seeing an exodus of staff as they grapple with long hours, hazardous conditions, and demanding workloads. This has led to a staffing shortage and higher demand. Many hospitals have to pay exponentially higher pay rates just to keep staff in place. This has pushed many hospitals in the nation to the brink of bankruptcy.

The recent requirement from CMS adds to the existing strains. Right from the outset, hospital staff that have made the personal decision to remain unvaccinated will now be subject to discipline and/or termination. But furthermore, even the staff that might already be vaccinated now have clear signals from the federal government that the hospital staff could be subjected to increasingly draconian measures. Instead of waiting for the next round of edicts that might put them on the blacklist, many within the hospital system may simply choose to head for the exit and look for other opportunities. After all, the tyranny that comes for your neighbor today can just as easily come for you tomorrow.

This state of affairs hinges back to the fundamental question before Mississippi when it considers Medicaid expansion. Of course, there are strong arguments against Medicaid expansion from fiscal and policy angles, and such arguments absolutely stand true. But the recent actions CMS shed light on another angle of the issue.

In the case of vaccine mandates for hospital employees, the state is forced to comply against her will. This particular mandate applied to expansion and non-expansion states. However, can the state really complain if it further invites this same federal agency with open arms through Medicaid expansion and freedoms are infringed on some other way at a later date? States that have expanded Medicaid have seen far more federal control than non-expansion states. And naturally, one shouldn’t be surprised. The “power of the purse” is very real, and the more the federal government funds something, the more it controls it No matter the lofty promises of Medicaid expansion, no one can calculate the value of the freedom of Mississippians into a spreadsheet. Even if the federal government made Medicaid expansion seem more enticing, the question of tradeoffs must be asked. At the end of the day, is there any price tag that would justify Mississippi handing over even more control to a federal government on a trajectory that is all but disconnected from the interests of the people of the state? If the price of “free money” from Washington is a reduction in freedom itself, then that is a price tag far too high to pay.


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