One would think that at this point, the Affordable Care Act (ACA) would be an unwelcome topic in the Missouri Legislature. Along with all of the technical problems, the program's website has actually been more effective at adding people to Medicaid rolls than it has been at getting people into private health insurance. Boosting rolls in a broken entitlement is bad enough, but expanding the pool of people who could join those rolls — which Obamacare would have Missouri do with Medicaid — would make matters even worse.

Thankfully, the state has not yet agreed to double down on Medicaid's problems, but that doesn't mean legislators won't do their best to justify taking the Obamacare cash next year, hawking Medicaid plans they say aren't "Obamacare"… but of course are. Early last month, the Wall Street Journal wrote an exceptional editorial about the coming marketing strategy with the headline "Obamacaid," explaining exactly what's coming down the pike in the state legislatures. (Emphasis mine.)

The feds are dangling the promise of paying for all the costs of the new beneficiaries, at least for the next three years. This subsidy honeypot can't last forever, and Governors are right to worry about taking on fiscal obligations that will increase 13% on average in 2014 under new Medicaid, according to a Kaiser Family Foundation state budget survey.

The Beltway boys and their allies in the hospital industry who are ravenous for more federal revenue are stunned that their bribery failed. So the new line of assault is to declare that the 26 conscientious objector states must hate poor people, or racial minorities, or Saint Peter and Christianity itself.

…If the sojourners for Medicaid were serious about helping the least fortunate, they'd try to repair its current dysfunctions. Start by prioritizing spending, and then give Governors waivers to manage case loads and make operations more efficient.

But the truth is that liberals view Medicaid as a national model, not a national disgrace. Coverage on ObamaCare's nominally private exchanges largely clones Medicaid's narrow networks of doctors and hospitals, low reimbursements, limited patient choice and heavy federal regulation. It might be more accurate to call it Obamacaid.

Medicaid reform is laudable and necessary, but proposals being circulated in Jefferson City seem to put the cart before the horse. The buzzword being used in Missouri to get the expansion over the top is "Medicaid transformation," but the proposals almost invariably start with a demand for Medicaid expansion, with the prospect of reform a secondary consideration. "Reform," in the present construction, only happens with expansion.

That's an utterly unacceptable prioritization of policy objectives. Medicaid is a broken program rife with waste, fraud and abuse, and may in some cases be worse for its patients than if they were completely uninsured. Compassion demands fixing a broken program, not forcing even more people into it. And that's to say nothing of the fiscal irresponsibility of using public debt indefinitely to deliver contemporaneous benefits.

Moreover, it is perplexing that some of the same people pushing a giant expansion of government through Medicaid also opposed allowing doctors to give free care to patients earlier this year. To be blunt: What sort of a worldview supports the expansion of a broken government bureaucracy and, at the same time, tries to prevent doctors from freely attending to the medical needs of their fellow Americans? It's an incredible contrast.

If proponents of a "transformation" aren't willing to reform Medicaid without an expansion, then I think it's fair to assume that they'd be about as happy to have the expansion without reform. That should be a non-starter. I hope that the leaders of the Medicaid "transformation" groups can and will proceed with reform but without expansion as a prerequisite.