CHARLESTON, W.Va. - West Virginia's Medicaid program now covers about 415,000 West Virginians. This costs federal taxpayers $2.2 billion a year, and state taxpayers $857 million - up from $764 million two years ago.
The state's costs are expected to rise to almost $900 million next year.
Democrats in Congress, in unilaterally passing the Affordable Care Act, ordered states to extend Medicaid coverage to people making as much as 133 percent of the poverty level as well.
If West Virginia were to do that, it would be covering about 130,000 more people, and state taxpayers' costs would rise even further.
Initially, congressional Democrats said magnanimously, the federal government would pay the entire cost of new Medicaid enrollees - their gift to the nation.
(This is the same federal government that runs trillion-dollar annual deficits, is borrowing 40 cents of every dollar it spends, and has brought the national debt to $16.4 trillion and rising.)
But in 2020, the federal government will pay only 90 percent of the cost of Medicaid, so Democrats in the West Virginia Legislature would need to scuffle up far more than $900 million a year to pay the state's share of "free" health insurance.
Gov. Earl Ray Tomblin has not yet said whether West Virginia wants to get on this fiscal roller coaster. Prudently, he has asked some questions of the federal government.
But West Virginians for Affordable Health Care contended this week that expansion of the welfare state - providing free health insurance instead of charity care - will contribute to economic development.
"There is no decision that Gov. Tomblin will make during his tenure as governor that will create more jobs or generate more economic activity than his decision to expand Medicaid," said Perry Bryant, the executive director of the group.
Families USA estimated that if the state provided taxpayer-subsidized health insurance to 100,000 more people, it would create 6,200 jobs and spread $664 million through the state's economy by 2016.
Now it's up to West Virginia Democrats, who do have to balance budgets, to decide if that is a rational expectation.