States Have No Good Reason for Refusing to Expand Medicaid


It’s a deal any state would be smart to take — but as many as a dozen might be about to say no regardless. They haven’t yet expanded Medicaid under the Affordable Care Act and are being offered enough federal money to cover the full cost, plus extra funds totaling nearly $10 billion over two years, to be spent at their discretion. The bargain would mean health coverage for 4.3 million of their most vulnerable people — enabling many of them to work, narrowing the racial health-care gap, creating new health-care jobs, and reducing hospital charity care.

The offer is part of the American Rescue Plan Act that Congress passed in early March. Politics explains why none of the 12 states has so far accepted it. The Republican governors or legislatures continue to resist, even to hate, Obamacare. Their constituents should let them know this strategy no longer works.

Voters in the recalcitrant states want Medicaid expansion. In Florida, where expanded Medicaid would insure more than 800,000 people, 73% of voters said they support it, according to The Commonwealth Fund, and that was before the stimulus act promised $3 billion in special funding. In Texas, where more than 1.5 million people could be insured and the state could receive an extra $5 billion, 67% said they favor expansion.

Three of the 12 holdout states may soon have ballot measures that could override their leaders’ resistance. In six states, that’s already happened.

Voters should ask why such strenuous efforts are necessary. Under the Affordable Care Act, the federal government pays 90% of the cost of extending Medicaid to all adults with incomes up to 138% of the poverty line — about $18,000 for a single person. (In most non-expansion states, Medicaid beneficiaries must have children and incomes well below the federal poverty level.) States accepting this basic arrangement find it costs them even less than the sticker price, because broader Medicaid coverage leads to savings on direct payments for mental-health treatment, health care for prisoners, and uncompensated medical care. In other words, the new enticements sweeten what was already a very good deal.

At least one small fissure in the wall of resistance has lately appeared: Governor Kay Ivey of Alabama has indicated she may be willing to discuss the possibility. What’s remarkable is that all 12 states haven’t already leapt at the opportunity. If this continues, citizens should take careful note — and act accordingly at the next election.

Editorials are written by the Bloomberg Opinion editorial board.

©2021 Bloomberg L.P.

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