Many states are balking at the expansion, even though it includes full federal funding for the first few years. Why?

Medicaid has become the single largest item in a state's budget. Any expansion, even with federal money, impacts their budget in the short term and especially in the long term.

With the expansion, Medicaid and Medicare will cover 120 million Americans, more than 35 percent of the population. While Medicare receives a large portion of its funding through premiums and taxes, Medicaid is 100 percent funded by the income tax, of which 53 percent of Americans do not pay any.

Of the Medicaid budget, 30 percent is for Medicare-eligible people, paying the additional costs of nursing homes and other co-payments based on income.

The questions of national health care has never been one of who deserves or who should provide the care. It has always been about "who pays." The state, federal government, individuals, or companies?

The fairest and most sustainable would be through direct taxation, like all of the other major countries that provide national health care.

Great Britain has a social tax of 13 percent on employees and the same on employers. This includes retirement (Social Security). In Canada it is a straight 10 percent health care tax.

We need to move health care off budget to a direct tax on individuals and businesses, equal to the projected cost.

Terry L. Hurst

Spotsylvania