The federal government covers the entire cost of expansion for the first three years. States will be expected to contribute 10 percent of the costs by the end of the decade, which is about one-third of the share they pay for their current Medicaid coverage.
Since states can opt in and out of Medicaid expansion at any point in time without any penalty from the federal government thanks to a 2012 Supreme Court decision, the 2014 election presents a unique opportunity.
Next November, millions of voters will have a chance to vote themselves health insurance by voting out Republicans.
As a thought experiment, let’s look at Texas, which has the highest uninsured population of any state in the union, both in numbers and percentage. About 1 in 4 Texans have no health insurance, meaning that more than 6 million people in the state lack coverage.
The Lone Star State’s Medicaid program is one of the stingiest in the nation. Childless adults are not eligible at all, no matter how little they earn.
Kaiser estimates that 1,046,430 Texas residents are in the coverage gap created by not expanding Medicaid, making this one state responsible for 1 out of 5 people who will be denied subsidized health insurance.
Other estimates suggest that between 1.4 million and 1.7 million people in the state would be eligible for the full expanded program. As all legal residents are eligible for Medicare and only citizens can vote, let’s assume that only half of the low-end estimate of eligible beneficiaries — 700,000 people — vote.
In 2010, Governor Rick Perry (R-TX) won re-election in a landslide.
His margin of victory? 631,178 votes.
Photo: Gage Skidmore via Flickr