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Friday, October 28, 2016

Due to a quirk in the Affordable Care Act, states that turn down Medicaid expansion will still have to cover legal immigrants who earn up to 133 percent of the poverty level.

This is an unintended consequence of the Supreme Court’s decision in 2012, which found that the individual insurance mandate in the law was Constitutional, but states had the right to reject the Medicaid expansion that was set to cover 17 million uninsured Americans beginning in 2014.

The federal government will cover 100 percent of the expansion at first, decreasing to 90 percent by 2020. Currently, states pay about 40 percent of their own Medicaid costs.

The requirement to cover immigrants puts Republican governors who oppose Obamacare in a difficult spot. Reportedly, it was behind Arizona governor Jan Brewer’s decision to accept Medicaid expansion, though she’s railed against the president’s signature program for years.

So Republican governors who say no to expansion will still have to cover legal immigrants—who can’t vote for them—while turning down coverage for hundreds of thousands of citizens who can. They also are potentially volunteering their residents to pay higher insurance rates while still subsidizing Medicaid expansion in other states, as states can’t opt out of the taxes that fund the law.

The growth of Medicaid was designed to drive down rates by greatly reducing the billions hospitals spend to cover so-called “free riders” who don’t have coverage but cannot be denied care, thanks to the Emergency Medical Treatment and Active Labor Act, which was signed into law by Ronald Reagan in 1986.

The growth of Medicaid was also supposed to be a hedge against a 75-percent cut in the payments the federal government offers for Medicare and Medicaid. This cut goes into effect whether the state accepts Medicaid expansion or not. Basically governors who reject the expansion are saying yes to public health care for immigrants and offering their citizens the chance to subsidize other states’ expansion, while paying more to cover fewer people in their own states.

This is why even red Texas — where Governor Rick Perry recently turned down over $200 million in federal funds just so he could defund Planned Parenthood — is being pressured to accept Obamacare, no matter how much Texans hate Obama. An independent analyst suggests that if Texas turns down expansion from the government, it will be rejecting $90 billion in economic activity, while leaving 1.5 million uninsured.

Currently 10 states have said they will not participate though the federal government has not set a deadline to accept. Presumably, states can still change their minds.

Photo credit: Gage Skidmore via

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  • docb

    Hah..they screwed themselves again..but their citizens too! ..Texas has no State Income Tax.. they are doubly screwed!

  • sleeve

    Karma is a beautiful thing.

  • bigal953

    These guys constantly box themselves into a corner.

  • That shows just how dumb these Republican governors are. If they had even half a brain they would have figured out they are screwing their own citizens just to get a dig in to Obama.

  • S-3

    I fSouth Carolina (my state) isn’t nuked eventually by its own people after hearing this (and realizinf they will never be able to have decent access to healthcare or be able to afford it ever again unless they know how to go through federal red tape), it’s because they got what they voted for or are too stupid to exist in the better world liberals and REAL conservatives want to create by actually compromising where necessary & working TOGETHER with the president – like they should be!

    • What worries me is the probability of uninsured people from red states that reject ACA moving to blue states to get the healthcare they need when they get sick and need surgery or other expensive treatments. Hopefully, the states that expand MEdICAID to fund ACA will put in place residency clauses that do not allow people from states that do not participate in the program to move and benefit from those who do.

    • jiggymama

      Lets create a new society for sane people only and no republicants.

  • I guess none of the TURD PARTY Governors had anyone read the fine print.

  • jiggymama

    Are we still on planet earth? I feel like I woke up on another planet in an alternate universe.

  • onedonewong

    Only in a socialist country can 30% of poverty payments go to illegals

  • mbee1

    This article is utter nonsense. The supreme court said no such thing. it said the individual mandate is legal so the legal working immigrants will have to buy insurance just like the working citizens. The parasites will have something to worry about if the states decide to stop throwing tax dollars at them, gasp they might just have to work for a living.

  • mbee1

    the free care cost argument is just as phony as this article. Hospitals charge 800 dollars for an aspirin in the emergency room and call that a losing service. There is zero reason to have emergency rooms big enough for the free care people and the actually emergency patients at the same time but for cost shifting that allows hospitals to pay their people extraordinary rates and gouge the taxpayers.