These States Are Missing Out on Billions by Refusing to Expand Medicaid
The fight over health care and the Affordable Care Act — also known as Obamacare — is one that simply won’t die. The legislation was signed into law all the way back in 2010, and we’re still fighting about it today. While it’s worked to get more people coverage, it’s come up short in other areas. And Republicans, by and large, still can’t stomach the fact that it remains the law of the land. This, despite numerous attempts to “repeal and replace” the law — all of which would lead to disastrous ends.
Under Obamacare, the expansion of Medicaid (a program that provides health care coverage to the poor) was meant to help get more people insurance. But whether or not a state expanded the program was up to the states themselves — and the governors, specifically. The issue is that many governors and states are fundamentally opposed to it, and have opted not to expand. Federal subsidies for expansion, as a result, are being left on the table. That means that for these states (19, currently) are leaving billions of dollars on the table.
Billions that could be spent providing health care services to the neediest. Using data from The New York Times and Avalere Health, here are the holdout states, and how much they’re forgoing by not expanding Medicaid.
These are the states that haven’t expanded Medicaid under Obamacare.
- Governor Scott Walker rejected federal funding, but still expanded Medicaid to 145,000 people.
Up until the 2016 election, Wisconsin was considered a blue state, despite having a Republican governor and reps like Paul Ryan, who both have issues with Obamacare and the Medicaid expansion. Nonetheless, Walker expanded Medicaid without taking federal funds, and it actually worked, to some degree. As a result, 145,000 people in Wisconsin gained coverage at a cost of $550 million — a cost which is now squarely on the shoulder of Wisconsin taxpayers.
Next: A deep-red state out west
- The least-populous state in the country could save up to 1.5% of its budget by accepting federal dollars.
Wyoming has advantages (or disadvantages, in some respects) from having a low population and no true urban environments. It makes things cheaper, typically, and as a result, the amount it could save by expanding Medicaid is less than in other states. But it’s still leaving money on the table, which could save the state’s taxpayers. There was an attempt, though it died after Trump’s election.
Next: As conservative of a state as there is
- 40% of Alabama’s children are on Medicaid.
A relatively poor, Southern state like Alabama has a lot to gain by expanding Medicaid. But it’s also a deeply conservative state and one in which residents have a lot of problems with programs like Obamacare. For that reason, Alabama’s leaders are unwilling to jump on board, leaving a lot of people who may otherwise gain coverage without it.
Next: There’s little hope for Medicaid expansion in this state.
- State budget deals have made Medicaid expansion even tougher.
In 2016, there was a strong push in Oklahoma to expand Medicaid and get more of the state’s poorest onto some sort of health care plan. It fell through, though, and plenty of people in the state were happy to see it fail. Still, the state’s equivalent program, called SoonerCare, helps more than 800,000 people per month — so there’s obviously a need and demand.
Next: “Thank God” for this state.
- If the expansion were to come to Mississippi, as many as 130,000 people could gain health coverage.
Some estimates show that expanding federal programs like Medicaid in the state of Mississippi would help hundreds of thousands of people, and create as many as 9,000 jobs in the process. But Mississippi, like its neighboring states, is deeply conservative, and the public is, by and large, dead-set against it.
Next: The home of prominent Republican politician Lindsey Graham.
14. South Carolina
- The state is giving up nearly $16 billion by keeping Medicaid as is.
Another Southern state that seems diametrically opposed to the idea of expanding federal health care programs is South Carolina. Like in other states, the concept had a flicker of life, briefly, in and around the state legislature. But it was snuffed out, even though 447,000 additional people would be able to get coverage if Medicaid were expanded.
Next: Another Southern state, but one that’s turning “purple”
- We’re not done in the South.
Georgia is another state that has been in a sort of limbo when it comes to expanding federal health care programs. The “wait and see” attitude toward Medicaid expansion has been adopted by many states, and Georgia is no different. There are talks of expanding the program in the state, but again, we’ll have to wait and see if a serious push is ever mounted.
Next: A state on the Great Plains
- Nebraska, too, is a state that’s content to sit on the sidelines when it comes to Obamacare.
Expanding Medicaid under Obamacare would provide health care coverage to an additional 97,000 Nebraska residents. Despite that, the state legislature is unwilling to pull the trigger. If it did, the state could benefit from more than $3 billion in federal subsidies to help offset the costs.
Next: A state that recently experienced a hard shift toward the Democrats
- A big Democratic swing in Virginia may mean the state expands Medicaid sooner rather than later.
Virginia is traditionally a swing state but has been getting “bluer” in recent years. A look at the most recent election (in November 2017) proves it. A newly minted Democratic governor may mean that Virginia sees health care expansion sooner than all the others on this list, which should cover an additional 400,000 people.
Next: One of America’s most important swing states
10. North Carolina
- Governor Roy Cooper says North Carolina residents are “already paying for” Medicaid expansion, though they see no benefits.
North Carolina, like Virginia, may be another state to expand the federal health care program sooner rather than later. A new Democratic governor is in place, though he’s still facing a conservative state legislature which will fight it tooth and nail. If a current plan goes through, Medicaid expansion could kick in during 2019 and cover an additional 1.9 million people.
Next: A state that’s experienced all sorts of trouble in recent years
- The Kansas legislature has done a lot to hurt the state’s residents and refusing federal subsidies could be included.
Let’s be honest: Seeing Kansas suddenly embrace Obamacare isn’t very likely. It’s another deeply conservative state — like several others we’ve covered — and many of the state’s voters are against expanding social programs. Kansas governor Sam Brownback ensured that Kansas didn’t expand Medicaid, and the state legislature couldn’t override him earlier this year.
Next: You “don’t mess” with this state
- Texas could cover an additional 2.5 million people by expanding Medicaid.
The great state of Texas is one of America’s largest and most populous. As such, there are a lot of people without health coverage, and 2.5 million of them could be helped by expanding Medicaid. But Texas leaders won’t do it, and as a result, are leaving $65 billion on the table.
Next: The resting place of Wild Bill Hickok
7. South Dakota
- Trump’s election may have prevented South Dakota’s governor from expanding Medicaid.
Governor Dennis Daugaard was looking to expand the program in his state of South Dakota but was convinced not to by Vice President Mike Pence. As a result, 59,000 people who would have gained coverage are still without it, and $2.1 billion in potential federal subsidies sits unclaimed.
Next: The swamp
- Another swing state, Florida could provide coverage to as many as 900,000 people if it expanded Medicaid.
Florida is another state in a precarious position — it has a big population with a lot of uninsured, but a Republican governor who’s been unwilling to expand federal programs like Medicaid. The total dollar amount of potential subsidies that Florida is giving up? More than $66 billion.
Next: Another western Republican stronghold
- Idaho’s state legislators, like so many others, can’t agree on Medicaid expansion.
Here’s yet another state that could benefit from expansion under Obamacare, but simply won’t do it. There are 78,000 people who fall into Idaho’s “coverage gap”, and tens of thousands would likely qualify for Medicaid. But again, the state’s leaders can’t agree on a fix and won’t opt for the federal subsidies.
Next: A state that passed Medicare expansion by ballot in 2017 — but may not see it go into effect
- Voters in Maine expanded Medicaid by ballot initiative. But the governor refuses to do it.
So, there are 18 states that haven’t expanded Medicaid. Maine is the 19th — it actually has expanded it, by ballot initiative. But the state’s governor, Paul LePage, has said that he’ll refuse to follow through. Where does it go from here? Since the governor has to implement the expansion, we’ll have to wait and see.
Next: The Show-Me State
- The hopes that expansion will come to Missouri are dead in the water.
Another state, but the same old story. Missouri is a “purplish” state that is home to a lot of people who would benefit from Medicaid expansion but has a legislature and governor who are opposed to it. As a result, those in the “coverage gap” are still there, waiting to see if anything will change.
Next: The reddest state out west
- 3.8% of Utah’s budget could be saved by accepting federal subsidies for Obamacare.
Utah is one of the country’s most conservative states, and as such, is a Republican stronghold. That has translated into policy decisions, and as a result, Utah hasn’t accepted federal money to expand Medicaid. But there is some movement to be noted — a waiver was recently signed allowing limited Medicaid expansion, helping as many as 6,000 gain coverage.
Finally: The Volunteer State hasn’t volunteered to expand Medicaid access.
- No state has more to gain by accepting federal subsidies than Tennessee.
The state of Tennessee could save 4.9% of its state budget in 2018 by accepting federal money and expanding Medicaid. But the state’s governor appears to have no interest. Instead, $22.5 billion is being left on the table, and more than 500,000 people are without coverage.
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