Nicole Hopkins' heartfelt account in the Wall Street Journal, "Obamacare Forced Mom Into Medicaid," describes the author's mother's experience with the Washington State Health Care Authority. The subheading sums it up: "My mother preferred to pay for her care rather than be on the government dole. Now she has no choice."

Ms. Hopkins writes that her mother Charlene grew up on a dairy farm, and was raised to believe that "taking government handouts is shameful":

For the truly poor, being institutionally forced to take welfare is demoralizing. The Affordable Care Act is at risk of systematizing learned helplessness by telling individuals like my mother that they cannot afford to care for themselves in the way they could before the law was enacted. "This makes me feel poorer than ever," she said.

It's striking how foreign this thinking is to statists like President Obama and his cohort. Charlene Hopkins was not an unfortunate casualty of ObamaCare; her experience is an essential part of the law's design. It's hardly a hidden conspiracy -- Obama consistently brags about expanding the Medicaid rolls. The phrase the White House uses repeatedly is that thelaw allows people to "gain access" to Medicaid.When the President and Debbie Wasserman Schultz boast that half a million people have successfully signed up for ObamaCare, (or "have begun applying"), Obama presents it as an accomplishment that 80% have been forced into Medicaid like Charlene Hopkins: "you've got almost 400,000 folks who could gain access to Medicaid under the Affordable Care Act." ("Could gain"? I thought it was a done deal.)

A March 2013 report from the Kaiser Family Foundation explains the ObamaCare strategy:

One of the primary goals of the Affordable Care Act (ACA) is to reduce the number of uninsured by creating a new continuum of coverage options through Medicaid and new health insurance exchange marketplaces that provides assistance to individuals with family incomes up to 400% of the federal poverty level (FPL). The ACA expands Medicaid to 138% FPL ($15,856 for an individual or $26,951 for a family of three in 2013) in 2014, which would make millions of adults newly eligible for the program.However, this expansion was effectively made a state option by the Supreme Court. If a state does not expand Medicaid, poor uninsured adults in that state will not gain a new coverage option and will likely remain uninsured.

Currently 16 states set Medicaid eligibility at less than 50% of the Federal Poverty Level (FPL). In 17 states the eligibility is between 50% and 99% of the FPL, and in the remaining 18 states (including DC) the threshold is 100%. ObamaCare sets a federal minimum of 133% FPL, but, Kaiser clarifies,"5% of an individual's income is disregarded, effectively raising the limit to 138% FPL."

At present, 25 states and the District of Columbia have agreed to expand Medicaid. The State of Washington, where Charlene Hopkins lives, is one of these, and the Washington State Health Care Authority "anticipate[s] a potential enrollment increase of about 325,000 new clients over several years."

The remaining 25 states object that expanding Medicaid will be costly and will limit their flexibility to design innovative programs to deal with health-care costs. Gov. Bobby Jindal, for example, cites estimates that "such an expansion would cost Louisiana more than a billion dollars over the first 10 years."

According to a story by Tara McGuinness on Whitehouse.gov, "Here's Why Every State Should Expand Medicaid Through Obamacare":

To provide states with the financial support for extending Medicaid, the Affordable Care Act directs the federal government to fully fund coverage in the first three years, and pay no less than 90 percent for coverage newly eligible individuals over time. This significant increase in federal funds is partly offset by lowering the special payments to hospitals for the uninsured, called disproportionate share hospital (DSH) payments.

Thus after the three-year grace period -- which happens to coincide with the end of Obama's presidency -- the states will be responsible for up to 10% of the costs of the new Medicaid "clients," which adds a significant budget burden.

The DSH allotment is currently an $11 billion federal program rarely mentioned in Mr. and Mrs. Obama's critiques of the heartless American medical system that existed before ObamaCare. The program is slated to be cut by $500 million in 2014, with cuts increasing to nearly half the total funding: $5 billion in 2018 and $5.6 billion in 2019. A health care consultant report summarizes:

"Altogether, the ACA requires $18.1 billion in total reductions from fiscal year (FY) 2014 through FY 2020, effectively halving the size of the safety-net program."

Reducing DSH funds will increasingly squeeze states refusing Medicaid expansion. In the words of Ms. McGuinness at the White House:

Hospitals that serve the most vulnerable are between a rock and a hard place -- but only until their governors and state legislatures act in their best interest, along with the best of their residents, businesses, and economy. [i.e., by going along with Medicaid expansion.]

This strategy, pursued aggressively by Obama, defies the intent of the Roberts' Court decision to refuse a federal mandate for Medicaid expansion, described by the New York Times as follows:

The court also substantially limited the law's expansion of Medicaid... Seven justices agreed that Congress had exceeded its constitutional authority by coercing states into participating in the expansion by threatening them with the loss of existing federal payments.

Thus the court denied coercion by means of withholding Medicaid funds, so the Administration, never one to fret about "exceeding its constitutional authority," coerces the states by slashing DSH payments.

Exceeding Constitutional authority means little to Obama because Obama's ends justify Obama's means; the president, like all Alinskiite Progressives, is convinced he knows what's best for the little people.

Ms. McGuinness quotes Lyndon Johnson's speech at the creation of Medicaid and Medicare, making a comparison to ObamaCare:

Because of this document... there are men and women in pain who will now find ease. There are those, alone in suffering who will now hear the sound of some approaching footsteps coming to help. There are those fearing the terrible darkness of despairing poverty... who will now look up to see the light of hope and realization.

These are noble-sounding sentiments that mask a paternalism rejected byself-reliant Americans like Charlene Hopkins.