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Tag: medicaid expansion

Millions Could Lose Health Coverage When Medicaid Emergency Ends

According to research from the Kaiser Family Foundation, somewhere between 5.3 million to 14.2 million low-income Americans could lose their Medicaid coverage if COVID public health emergency declarations expire on July 15.

The declaration is expected to be renewed, however, the KFF analysis points to the precarious health care faced by many Americans .

Medicaid enrollment increased by nearly 25 percent throughout the pandemic as the federal government implemented a continuous enrollment requirement. This cost $47.2 billion, but the federal government granted Medicaid about $100 billion to cover the costs related to continuous enrollment.

The wide estimate of 5.3-14.2 million Americans at risk of losing their Medicaid coverage is due to uncertainty over how individual states will respond to the looming end of the emergency declaration.

The Department of Health and Human Services has renewed the emergency declaration regularly throughout the pandemic, and HHS is required to provide a 60-day notice to states if the declaration will not be renewed. However, HHS has not yet set an extension date.

More Expensive Healthcare?

In addition to questions about how long continuous enrollment will keep Americans on Medicaid, the federal subsidies that reduced the price of marketplace health insurance could be gone at the end of 2022.

In tandem with increased Medicaid coverage, the federal government subsidized private insurance beyond what the ACA already does. If those additional subsidies end at the end of 2022, millions will likely see their monthly premiums increase.

Not only did Medicaid see an enrollment spike, but Obamacare enrollment reached its highest level ever during the pandemic at 14.5 million Americans. Enrollees received subsidized marketplace insurance as well as a longer enrollment period, and more public messaging was spent on ACA enrollment.

Some healthcare advocates have argued that the increased subsidies for marketplace insurance should remain in place when the public health emergency declaration and continuous enrollment for Medicaid are peeled back. People who lose Medicaid coverage would then have the option to enroll in the subsidized marketplace insurance.

The Build Back Better Act had a provision in place to decouple Medicaid continuous enrollment and subsidized marketplace insurance from COVID emergency measures. The legislation would extend subsidized insurance until 2025, but the bill is currently in legislative limbo after Democratic Senator Joe Manchin pulled his support in March.

What the Future Holds

Another renewal of the COVID emergency declaration would postpone worries of lost Medicaid coverage until mid-October, but many Americans will still be living in healthcare insecurity when the next deadline rolls around.

A lack of clarity about the future also puts healthcare workers, already facing long hours and staffing shortages, in a worrisome position, already facing long hours and staffing issues

Jana Eubank, executive director of the Texas Association of Community Health Centers told The Texas Tribune, “We already have a huge uninsured issue in this state, and this [the end of continuous Medicaid enrollment] just could be a perfect storm. We’re busting at the seams. … The last thing we need are more uninsured people.”

Americans living in red states face a particularly daunting task when acquiring healthcare. Texas has the highest number of uninsured people per capita and is one of the 12 states that has refused to expand access to Medicaid as part of the ACA. The other states are Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Wisconsin, and Wyoming.

Individual states have considerable power over who can enroll in Medicaid, and their power is set to further expand in the realm of abortion rights after the leaked Supreme Court draft that would overturn Roe vs. Wade.

To expand access to healthcare in these states, some have proposed increasing the subsidies for marketplace insurance to include higher levels of income.

What remains clear in these debates is that a significant number of Americans are at risk of losing health insurance and more permanent action is needed to prevent an increase in the uninsured.

Republicans Launch Attack On 'Imaginary' Version Of Build Back Better Bill

Congressional Republicans are warning that President Joe Biden's $1.75 trillion Build Back Better plan could cost a lot more — if it contained a lot of provisions that it does not contain.

Rather than explain their opposition to what's in the popular climate and caregiving infrastructure package, they are instead attacking a nonexistent proposal to spend trillions of dollars more.

On Friday, the nonpartisan Congressional Budget Office and Joint Committee on Taxation released an estimate of what it called "a modified version of H.R. 5376, the Build Back Better Act, that would make various policies permanent rather than temporary

."The budget office took provisions of the actual bill, such as the child tax credit and Medicaid expansion, and assessed how much more it would cost if each were to be extended for all time. Doing so would make the ten-year $1.75 trillion plan into a $4.9 trillion bill and would require additional revenue or deficit spending, the budget office found.

GOP lawmakers seized on the CBO's theoretical projections to falsely assert that the numbers reflected the real price of the Build Back Better spending package.

"The true cost of the bill has more than doubled and the effect on the deficit is eightfold," argued Sen. Lindsey Graham (R-SC), who sits on the Senate Budget Committee.

"Today’s CBO score exposes the budget gimmicks Democrats have been using to hide the true cost of their tax & spending plan," wrote Rep. Jason Smith (R-MO), the top Republican on the House Budget Committee. "CBO has confirmed their bill spends $4.9 trillion and adds $3 trillion to the debt – trillions more than Democrats claimed."

"The Congressional Budget Office found that the actual cost of Biden's spending bill is $3 TRILLION in new deficit spending," claimed Sen. Tom Cotton (R-AR).

"On the same day news broke that inflation has hit a nearly 40-year high, the CBO announces the true cost of the #BuildBackBroke agenda," said Rep. Maria Elvira Salazar (R-FL). "$3 TRILLION. Americans can't afford Washington's spending problems."

In a press release, House Speaker Nancy Pelosi (D-CA) mocked Graham and his GOP colleagues for hyping the "CBO score of an imaginary bill."

"Congress and President Biden have made clear: any future extensions of the life-changing provisions of Build Back Better will be fully paid for, as they are today," Pelosi said in a statement.

Graham and Smith requested the analysis last month, demanding that it be completed before the House voted on the package, but Democrats passed the package nonetheless. The resolution now waits for a vote in the Senate.

Published with permission of The American Independent Foundation.

After 55 Years Of Medicare And Medicaid, Let’s Expand Those Systems, Not Cut Them

This article was produced by Economy for All, a project of the Independent Media Institute.

On July 30, 1965, President Lyndon B. Johnson signed Medicare and Medicaid into law. This crowning achievement was both the culmination of a decades-long effort to attain guaranteed universal health insurance and the first step in the quest for Medicare for All.

In the 55 years since the legislation was signed into law, both programs have proven their worth. Before Medicare, about half of seniors lacked health insurance. They were an illness away from bankruptcy. Today, 99.1 percent of Americans 65 and older are insured, thanks to Medicare. Nine million people with disabilities who are under age 65 also have health insurance coverage through Medicare.

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Democrats Seek To Expand Obamacare As Trump Tries Again To Kill It

House Democrats introduced legislation on Wednesday to expand access to health care and lower the cost of prescription drugs.

The Patient Protection and Affordable Care Enhancement Act was unveiled just days before the Trump administration is scheduled to file a brief with the Supreme Court arguing to eliminate the Affordable Care Act.

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Study: GOP Rejection Of Medicaid Funds Caused Over 15,000 Unnecessary Deaths

Republican opposition to the Affordable Care Act (ACA) appears to have deadly consequences, according to a July study from the National Bureau of Economic Research (NBER).

“Our estimates suggest that approximately 15,600 deaths would have been averted had the ACA expansions been adopted nationwide as originally intended by the ACA,” Sarah Miller, Sean Altekruse, Norman Johnson, and Laura R. Wherry wrote in the NBER study.

The study examined the mortality rates among low-income people aged 55 to 64 in states that opted to expand Medicaid under the ACA and those that did not.

When the ACA became law, states had the option of expanding Medicaid eligibility to nearly all low-income people, with the federal government covering nearly all the cost, according to the Kaiser Family Foundation. Still, 14 states from Georgia to Florida to Texas — all with either Republican governors, Republican legislatures, or both — refused to do so.

According to the study, more than 13.5 million people were able to obtain health insurance in the states that embraced the Medicaid expansion. “Our analysis provides new evidence that Medicaid coverage reduces mortality rates among low-income adults,” the authors wrote.

In a state like Texas, the decision to refuse the Medicaid expansion meant approximately 750,000 people were forced to live without a viable health insurance option, even though one could have been available to them under the ACA.

In May 2013, then-Gov. Rick Perry dismissed expanding Medicaid as “foolish,” saying, “Texas will not be held hostage by the Obama administration’s attempt to force us into this fool’s errand of adding more than a million Texans to a broken system.”

In 2015, Republican Gov. Greg Abbott reiterated his party’s position against Medicaid expansion, saying, “Medicaid expansion is wrong for Texas.”

The decision does not sit will with all Texas residents.

“It felt like in Charles Dickens’ A Christmas Carol when Scrooge says, ‘Let them die and reduce the surplus population,'” Tanya Walker told the Texas Tribune in 2018 about her state’s refusal to expand Medicaid eligibility. “That’s how I felt other Texans and my legislators felt about the working poor, ‘If you can’t afford insurance then we don’t care about you.'”

And Texas politicians are not only refusing to expand Medicaid in their own state, but trying to rip away health care from millions in other states as well. Texas is leading a multi-state lawsuit seeking to declare the entire ACA unconstitutional.

If the GOP-led lawsuit is successful, the entirety of the Medicaid expansion would go away, leaving millions without sufficient access to health care.

And based on the results of the NEBR study, that outcome could be deadly for tens of thousands of low-income Americans.

Published with permission of The American Independent.

The 5 Cruelest Actual GOP Policies

You didn’t see Saturday Night Live‘s “Establishment Shuffle” sketch on national television because it didn’t make the actual show. But it’s probably the best summary of the 2016 GOP primary that you’ll find.

In it, the dignified Paul Ryan — who almost had America intentionally default on its debt because President Obama wouldn’t agree to enough cuts to Social Security and Medicare — explains that Trump’s proud racism and erratic demagoguery don’t represent the establishment Republican Party, which prides itself on subtle, coded racism in service of a constant and unwavering effort to undo everything that built the middle class.

The extremism of the GOP establishment becomes more obvious every day as it rushes to support Ted Cruz’s efforts to swipe the nomination from Trump — and deliver it to a Senator who would be the most extreme national candidate since at least Barry Goldwater, and possibly since shoelaces were invented.

The GOP has never stopped catering to the catered and victimizing victims, but it’s worse than ever now. Trump’s cruelty-as-qualification runs on these very instincts, but turns off the voters Republicans need to win a general election. At this point, the billion-dollar baby’s brutality is all theoretical. But Republican cruelty is actual policy, and it has decimated states like Louisiana and Kansas, where the empty promises behind tax cuts for the rich are repaid with the blood, sweat, and fears of low-wage workers.

Saturday’s Boston Globe supplement imagines the damage a President Trump could do. But let’s not forget the damage being done by the Republican right at this very moment:

  1. Denying millions of the hardest working, most desperate Americans Medicaid expansion, for no good reason.
    Look at Texas to see the lengths the GOP will go to deny poor people basic health care. The state with the highest uninsured rate in the nation is turning down billions of dollars, forcing residents to pay higher insurance rates and letting thousands die rather than accept Medicaid expansion paid for almost entirely by the federal government. In addition, the state’s war on Planned Parenthood has driven between 100,000 and 240,000 women in the state to attempt to end a pregnancy themselves. Florida and 17 other states are doing their best to duplicate Texas’ efforts to punish the poorest working people in the state with third world health care.
  2. Trying to delegitimize the Veterans Administration after overloading it with suffering servicemen.
    Like any other Republican-driven “crisis,” there’s much more to the VA than what’s being reported. Exploiting an overloaded system, right-wing billionaires are attempting to destroy what has been the nation’s most effective means of delivering health care for veterans. “Working through the [Concerned Veterans of America], and in partnership with key Republicans and corporate medical interests, the Koch brothers’ web of affiliates has succeeded in manufacturing or vastly exaggerating ‘scandals’ at the VA as part of a larger campaign to delegitimize publicly provided health care,” Alicia Mundy writes in an explosive expose for the Washington Monthly. “All this has been happening, ironically, even as most vets who use the system and all the major veterans’ service organizations (VSOs) applaud the quality of VA health care.” There are problems in the system, no doubt. But they are problems consistent with an American health care system both underfunded and egregiously costly, thanks to the right’s aversion to government expansion.
  3. Unmooring struggling communities with the destruction of public education. 
    “School choice” is a perfectly poll-tested term for the conspiracy to undermine community schools that also — how convenient — just happens to target the last effective bulwark against Republican revanchism, teachers’ unions. School choice as a phrase is promising, but again and again, introducing “competition” to one of our most treasured institutions, public education, has uprooted the fabric of communities that have little holding them together. In Michigan a new study finds that “choice” students “fare no better on state standardized tests than similar students who stay in their home districts.” And what do students get in return for empty promises and classroom disruption? Mitchell Robinson, an associate professor and chair of music education at Michigan State University, called school choice “a scam designed to defund poor urban school districts and destabilize public education.”
  4. Purposely keeping wages as low as possible.
    Next year will mark a full decade since the lowest paid Americans got a federal minimum wage increase — so long ago that many states and localities have given up waiting for Republicans in Congress to act. In response to the Fight for Fifteen movement’s activism, city councils are addressing minimum wage increases at the local level, despite state legislatures’ interventions. Meanwhile, many of the same states enforce anti-union measures that purposely lower wages for all workers. Elected Republicans are doing their best to act on Donald Trump’s call that wages are too damn high.
  5. Doing whatever they can to make global warming worse.
    New research suggests that “the disaster scenario” of the West Antarctic ice sheet breaking off, melting, and raising ocean levels by as much as 12 feet could happen much sooner than expected. And Republicans are furious that President Obama is trying to do something about it. Why? Because the effects of climate change will, generally, fall hardest upon the world’s poor: those unable to cope with the devastating effects of drought, flood, and famine. That, or they really believe what Trump said: that global warming is a conspiracy invented by the Chinese.

Photo: Republican U.S. presidential candidate Texas Senator Ted Cruz waves as he arrives to speak at the 2016 Conservative Political Action Conference (CPAC) at National Harbor, Maryland March 4, 2016. REUTERS/Joshua Roberts 

More States Lean Toward Medicaid Expansion

By Christine Vestal, (TNS)

WASHINGTON — The federal government last week approved Indiana’s plan to expand Medicaid under the Affordable Care Act, increasing the number of expansion states to 28, and the District of Columbia. Indiana’s plan could add an estimated 350,000 low-income adults to the nearly 5 million expected to enroll in the 27 states that expanded Medicaid last year.

In accepting Indiana’s plan, the Obama administration demonstrated its determination to increase the number of expansion states, even if it means waiving longtime Medicaid rules. For example, under Indiana’s plan, people with incomes above the federal poverty level ($11,670 for an individual) must contribute to a health savings account or be locked out of coverage for six months.

The penalty for not paying into a health savings account, which has never before been approved by the U.S. Department of Health and Human Services, reflects an important Republican health care tenet: People who receive Medicaid benefits should take personal responsibility for their care. Republican Gov. Mike Pence called his plan “the first-ever consumer-driven health care plan for a low-income population.”

Judith Solomon, health policy director at the Center on Budget and Policy Priorities, which advocates for low-income people, noted that Indiana’s plan is derived from a successful demonstration project that has been in effect since 2007, so its approval doesn’t necessarily apply to other states.

Under the Medicaid expansion that is part of the Affordable Care Act, the federal government pays the full price for covering newly eligible adults with incomes up to 138 percent of the federal poverty level ($16,105) through 2016, and then gradually lowers its share to 90 percent in 2020 and beyond.

Since the Supreme Court’s 2012 decision making Medicaid expansion a state option, the issue has become more political than practical. Despite the offer of billions of dollars in federal aid, Republican governors and lawmakers in many states have rejected the deal, fearing they could lose their jobs if they were seen cooperating with the Obama administration on a law most conservatives disagree with. Some states also worry that even the 10 percent share may be too much for them to afford, or that the federal government will scale back its contribution sometime in the future.

Since the Nov. 4 elections, those fears seem to have subsided, said Joan Alker, director of the Georgetown University Center for Children and Families, which advocates Medicaid expansion.

After last year’s elections, governors in Alaska, Idaho, Montana, Tennessee, Utah and Wyoming asked lawmakers to approve detailed proposals for expanding the federal-state health plan for low-income adults, in some cases restarting previous efforts to seek approval for expansion.

In a smaller group of states in the South — Alabama, North Carolina and Texas — governors said for the first time they were open to the idea of expanding Medicaid. Other than Arkansas, no Southern state has done so.

If all six states now considering expansion plans win federal approval, more than 600,000 additional people could be eligible for Medicaid coverage.

Following is a rundown of Medicaid expansion proposals in the states most likely to move forward this year:

Alaska: Newly elected Gov. Bill Walker, the nation’s only Independent governor, wants to cover about 20,000 Alaskans through traditional Medicaid starting July 1. If state lawmakers agree with the governor’s plan, Alaska could be the next state to start enrolling newly eligible adults this year.

According to a study by The Urban Institute, Walker’s expansion plan would cut the state’s uninsured rate by more than half. Another study, commissioned by the state health agency, predicts that between July of this year and 2020, expansion would save Alaska $29 million as the federal government picks up some health care costs the state is bearing now.

Republican lawmakers, who hold a majority in both chambers of the legislature, have agreed to hear evidence from the Walker administration on the benefits of expansion for the state’s budget and economy. But most oppose the plan on principle, and a multibillion-dollar budget gap and crashing oil prices compete for their attention.

Idaho: In his Jan. 12 State of the State address, Republican Gov. Butch Otter asked lawmakers to consider evidence in favor of expanding Medicaid to 103,000 low-income Idahoans through a customized expansion plan.

Under a proposal presented in a paper by a working group Otter appointed in 2012, residents with incomes below the federal poverty level would be assigned to a managed-care plan within the existing Medicaid program. Residents with incomes between 100 percent and 138 percent of the federal poverty level could sign up for a private insurance plan on the exchange, much like Arkansas residents.

If lawmakers pass Otter’s plan, which he says has the tacit approval of the federal government, the state could save $173 million over the next 10 years as more costs are covered under the higher federal match rate.

Montana: Democratic Gov. Steve Bullock asked lawmakers last month to approve legislation, the Healthy Montana Plan, that would expand traditional Medicaid coverage to about 70,000 Montanans. Republican lawmakers, who control both houses of the legislature, have proposed an alternative plan that would use state money instead of accepting money from the Obama administration and would limit coverage to about 15,000 low-income parents and veterans.

In 2013, a Medicaid expansion bill nearly passed the Montana Legislature. But a Democratic lawmaker who intended to vote for it accidentally pressed the wrong button. His vote could not be changed because a state law says legislative voting errors cannot be corrected if they would affect the outcome of the vote. The legislature did not meet the following year. This year, the legislature is in session and the balance of power is about the same as it was in 2013.

Tennessee: In December, Republican Gov. Bill Haslam announced he was close to an agreement with the federal government on an alternative expansion plan called Insure Tennessee. Under the proposal, the state would provide vouchers to help low-income residents pay premiums for employer-sponsored insurance. Low-income residents without employer-offered plans would receive coverage through a plan resembling a health reimbursement account, with premiums and co-payments for people with incomes above the federal poverty line.

Insure Tennessee, which would cover more than 300,000 residents, has been under consideration by the federal government for nearly two years.

Utah: Early last year, Republican Gov. Gary Herbert announced details of a plan to expand Medicaid to about 95,000 low-income adults using private insurance, similar to Arkansas’ plan. It would require low-income Utahans to show that they are making an effort to find jobs to qualify for coverage. Last month, he renewed his push to seek legislative approval for his proposal.

Wyoming: Republican Gov. Matt Mead has been discussing an alternative Medicaid expansion idea with the federal government since last summer. In November, he released details of Wyoming’s “Strategy for Health, Access, Responsibility and Employment,” which would cover an estimated 17,000 residents. All participants would make co-payments, and those with incomes above the federal poverty level would pay monthly premiums of $25 to $50. All participants would have access to employment assistance programs like job search services and vocational rehabilitation, but their Medicaid eligibility would not be affected.

The biggest nonexpansion states are Florida and Texas, where expansion would add a total of 2.6 million uninsured residents to the Medicaid rolls. But both the Florida and Texas legislatures are dominated by Republicans, and expansion remains a long shot.

Alabama and North Carolina also are deeply Republican but Republican governors Robert Bentley of Alabama and Pat McCrory of North Carolina both have made comments recently suggesting they are open to the idea of expanding Medicaid.

McCrory announced in January he has had preliminary discussions with the Obama administration about customizing the state’s approach to expansion. In December, Bentley told state lawmakers he would be open to a Medicaid expansion along the lines of Arkansas’ “private option,” under which newly eligible Medicaid beneficiaries purchase private health plans on the insurance exchange. Neither governor has made public a detailed proposal.

In Florida and Texas, billion-dollar federal Medicaid funds to compensate hospitals for unreimbursed care are set to expire soon — Florida’s in June and Texas’ in September 2016. Those impending deadlines and other provisions of the ACA are draining hospital revenue in both states. As a result, hospitals are pressuring both governors and Republican lawmakers to allow them to tap into the health care law’s intended countervailing benefits for hospitals by insuring more residents through a Medicaid expansion.

Republican Gov. Rick Scott of Florida announced his support for expanding Medicaid in 2013, but has not spent any political capital to make it happen. In Texas, former Republican Gov. Rick Perry was among the nation’s fiercest critics of the ACA. But his Republican successor, Greg Abbott, told a group of lawmakers in a private meeting in December that he wanted to know more about Utah’s alternative model for expansion, according to the Houston Chronicle.

Photo of Governor Bill Haslam: Nashville Area Chamber of Commerce via Flickr

States That Decline To Expand Medicaid Give Up Billions In Aid

By Tony Pugh, McClatchy Washington Bureau

WASHINGTON — If the 23 states that have rejected expanding Medicaid under the 2010 health-care law continue to do so for the next eight years, they’ll pay $152 billion to extend the program in other states — while receiving nothing in return.

This exodus of federal tax dollars from 2013 through 2022 would pay 37 percent of the cost to expand Medicaid in the 27 remaining states and Washington, D.C., over that time.

Most of the money, nearly $88 billion, would come from taxpayers in just five nonexpansion states: Texas, Florida, North Carolina, Georgia, and Virginia.

The findings are part of a McClatchy analysis of data from the Urban Institute, a nonpartisan research center that’s advised states on implementing the health-care law, the Affordable Care Act.

Non-expansion states would see direct benefits from their $152 billion only if they reversed course and expanded eligibility for Medicaid, the state and federal health program for low-income Americans. The health-care law provides financial incentives for states to extend Medicaid coverage to adults who earn up to 138 percent of the federal poverty level.

If the non-expansion states did so, they’d still have to pay the $152 billion. But the 23 states also would split nearly $386 billion in federal Medicaid funding from 2013 to 2022, according to Urban Institute estimates.

The money would cover all medical costs for newly eligible Medicaid enrollees from 2014 through 2016, and no less than 90 percent of their costs thereafter.

“Here is money that is pretty much there for the asking, and these states are turning it down. And in the meantime, their taxpayers are paying taxes that fund expansions in states that are moving forward. It just doesn’t make any sense,” said Sherry Glied, the dean of the Robert F. Wagner Graduate School of Public Service at New York University.

The federal funding under Medicaid expansion also would stimulate economic activity, boost tax revenue, and create hundreds of thousands of jobs in the non-expansion states, experts say.

“This additional use of medical services not only brings more federal dollars, but hospitals, physicians, and pharmacies would likely hire more people, keep longer hours, and probably raise wages. All of which leads to indirect spending and subsequent rounds of spending that generate tax revenues and, in general, the expansion of the economy within states,” said Michael Morrisey, a health economics professor at the University of Alabama at Birmingham.

Expansion opponents doubt the federal government’s long-term ability to fund 90 percent of the cost for new enrollees. They also worry that their states can’t afford the increased Medicaid costs that come with expansion.

“We’re already struggling as a state, financially, to find the money to support our existing Medicaid system,” said Georgia Republican state Rep. Jason Shaw. “It’s really tough times for the state. It just wouldn’t be fair to the taxpayers if we just accepted the expansion.”

Some critics think the expansion encourages government dependency by providing free and low-cost health coverage for some while requiring those with higher incomes to pay full price. Those concerns have made expansion a tough sell in the holdout states, where Republican lawmakers want to curb enrollment growth in Medicaid no matter how sweet the financial incentives may be.

Last week, Pennsylvania became the ninth state with a Republican governor to accept the expansion. Like Arkansas and Iowa, Pennsylvania won approval from the Obama administration to bypass the Medicaid program and use the federal funding to help low-income residents buy private coverage instead.

Indiana and Utah, two other states with Republican governors, also are working with the Obama administration to enact their own versions of the Medicaid expansion. Many experts think that kind of federal flexibility will help Medicaid expansion work in most red states one day.

But in the run-up to the first midterm elections since the health law was fully implemented, expansion remains a hot-button issue. While polls show the Affordable Care Act remains largely unpopular, Democratic candidates in Republican-led states are campaigning for the expansion, citing the financial benefits.

Medicaid is a key element of the Affordable Care Act’s goal to provide near-universal coverage for millions of Americans. Since last October, more than 7.2 million people have gained Medicaid coverage, largely through the expansion.

In the 27 expansion states, single adults who earn up to $16,105 a year are eligible for Medicaid coverage, as are families of four that earn up to $32,913.

Expanding Medicaid coverage in the 23 remaining states would increase their state budget costs by $28.8 billion from 2013 through 2022, the Urban Institute reports. Expansion in Georgia, for instance, would hike its expenses by $2.5 billion over the 10 years, according to the institute.

“We simply cannot afford the $2.5 billion in new spending that expansion would require,” said Sasha Dlugolenski, a spokeswoman for Gov. Deal. “I think everyone can agree on one thing: The expansion costs money the state does not have.”

But experts say the increased revenue a state would see from expansion would more than make up for the state’s additional Medicaid spending.

Revenue gains for Alabama and Mississippi would exceed their expansion costs by $935 million and $848 million, respectively, according to a study co-authored by Morrisey, of the University of Alabama.

Those kinds of projections have led Republican state Rep. Steve Clouse, the chairman of the Alabama Legislature’s Ways and Means General Fund Committee, to support expanding Medicaid, even though he favors repealing and replacing the Affordable Care Act.

“We’ve got to deal with the hand we’ve been dealt by the feds,” Clouse said.

AFP Photo/Brendan Smialowski

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