Study: States refusing Medicaid expansion would benefit the most

There are more than 15 million uninsured or underinsured people living below the poverty line in the 23 states that have refused to expand Medicaid under ObamaCare, according to a new study by The Commonwealth Fund.


Many of these states have among the highest rates of uninsured or underinsured people in the country, the study found.

“Without Medicaid expansion, this vulnerable group will remain at high risk for access, health, and financial problems,” the study says.

In Texas, nearly 40 percent are uninsured or underinsured. Florida, Idaho, Montana, Mississippi, Louisiana, Wyoming, Georgia and North Carolina also rank near the top of the list of uninsured or underinsured.

Republican-led legislatures and governors in these states have so far refused federal dollars to expand Medicaid.

“The vast majority of people struggling to afford health care are low- and middle- income, and exactly the people the Affordable Care Act was designed to help,” Commonwealth Fund Senior Vice President Cathy Schoen said in a statement. “This report demonstrates that the health reform law was accurately targeted toward the needs of the uninsured and underinsured. However, if all states don’t expand Medicaid, millions will still go without health insurance and health care.”

Florida Gov. Rick Scott (R) initially supported the Medicaid expansion, but reversed course when he announced in December that he was running for reelection. Others, like Govs. Rick PerryRick PerryTrump's relocation of the Bureau of Land Management was part of a familiar Republican playbook What we've learned from the Meadows documents Trump war with GOP seeps into midterms MORE (R-Tex.) and Bobby Jindal (R-La.), have been openly hostile to the expansion from the start.

Republican governors and legislators argue the policy would ultimately drain state coffers by increasing Medicaid rolls, and they fear the federal government won’t keep its funding promise, leaving them on the hook.

Under the Affordable Care Act, the federal government pays 100 percent of the costs of the state’s expansion for the first year, and most states wouldn’t pay more than 10 percent in future years.

So far, 22 states and the District of Columbia have said they’ll expand Medicaid under the law, 19 states have said they will not, four have come to an alternative workaround agreement with the administration, and five are still considering a potential workaround.
Health and Human Services Secretary Kathleen SebeliusKathleen Sebelius65 former governors, mayors back bipartisan infrastructure deal Fauci: 'Horrifying' to hear CPAC crowd cheering anti-vaccination remarks The Memo: Biden and Democrats face dilemma on vaccine mandates MORE has lashed out at the governors in some of the states that are refusing the federal dollars for the Medicaid expansion, accusing them of “playing politics with people’s lives.”

While overall support for ObamaCare remains low, some Democrats hope to gain politically from GOP opposition to the Medicaid expansion. In Louisiana, vulnerable Sen. Mary Landrieu (D) has attacked both Jindal and her opponent on the issue.

The Affordable Care Act was written under the assumption that all states would be expanding Medicaid, but a Supreme Court decision ruled that states could opt out. That means many people in those states won’t only be missing out on Medicaid, they also won’t qualify for premium subsidies under the law.

“In states that do not expand Medicaid, those with income below poverty will have no new options available,” the study said.