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According to an Urban Institute study, if all 50 states expanded Medicaid, “an estimated 10.3 million poor uninsured adults would have new options for insurance coverage.”

Unfortunately, because the Affordable Care Act gives states the right to decide whether or not to expand Medicaid — the law provides complete funding of Medicaid for the next three years, which means the cost of expansion is covered by the federal government, not the states — many Republican-controlled states across the nation have rejected expansion of the program that offers coverage to the poor, elderly, and disabled.

In the 25 states that have decided against expanding Medicaid as of January, the study finds that an estimated 5.8 million Americans – accounting for 27.2 percent of all uninsured adults nationwide — will not be eligible for health coverage through the program.

The reasons have overwhelmingly been tied to ideology and party politics. GOP lawmakers have argued that Medicaid expansion is “big government” intrusion and detrimental to state economies.

According to the report, in many of these states, uninsured residents with incomes between 100 and 138 percent of the federal poverty level may qualify for subsidies to purchase coverage through the federally run exchanges. Uninsured adults with incomes below the poverty level will not have access to any new coverage options.

Several states that have opted out of expanding Medicaid are considering alternative plans that would offer coverage to their poorest residents. Pennsylvania, Utah, and New Hampshire – among the 25 states not expanding Medicaid included in the study – are adopting variations of Arkansas’ “private option” plan that would use federal funds to subsidize private coverage for low-income residents.

But in states that are not considering alternative plans, poor adults will not have access to any coverage. Of the 10.3 million adults that could have benefited from a Medicaid expansion, only 4.4 million – accounting for 21.2 percent of the nation’s uninsured adults — will definitely be eligible for Medicaid coverage.

More alarming is that most of the states that have rejected Medicaid expansion and are not considering alternative plans to protect patients have some of the highest rates of uninsured individuals in the nation.

According to a report released by Gallup in February, the number of uninsured Americans across the nation has risen to 17.3 percent in 2013 from 14.8 percent in 2008. Texas has the highest uninsured rate: 27 percent of residents do not have access to health insurance. Still, Texas has fervently opposed the idea of Medicaid expansion. Mississippi, Florida, and Louisiana – the states with the third, fourth, and fifth highest rates of uninsured residents, respectively – have also rejected Medicaid expansion.

“A pattern has emerged that reveals that states with the highest rates of uninsured residents are among the least likely to expand Medicaid and to establish state-based exchanges,” Gallup’s Dan Witters noted in the report.

States that refuse to expand Medicaid and establish marketplaces will lose billions of dollars that the federal government would have provided.

Photo: ProgressOhio via Flickr


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