Alaska’s Republican-turned-Independent Governor Bill Walker unilaterally moved today to accept federal funds for a Medicaid expansion. Alaska will become the 31st state, plus the District of Columbia, to accept money made available from the Affordable Care Act to provide health care coverage to anyone who makes less than 133 percent of the poverty line. The move will make an additional 42,000 people eligible for Medicaid coverage.
While this Gov. Walker has taken a step in the right direction, unlike Wisconsin's governor and presidential candidate Scott Walker, 19 states continue to refuse federal funds to cover a Medicaid expansion. This has left 3.7 million people uninsured who would otherwise have been covered under the ACA, or 10 percent of the 40 million currently uninsured Americans.
It makes little sense to refuse expansion. The government covers all costs of the expansion until 2016, at which point it will gradually lower its share of the costs to 90 percent by 2020. In light of the minimal costs shouldered by states, the only real effect of refusing expansion is to prevent poor people from receiving life-saving medical care.
Medicaid expansion is also extremely important to making Obamacare work. The law originally required states to expand the program, but the Supreme Court deemed this requirement unconstitutional in National Federation of Independent Business v. Sebelius. The expansion covers those who are too poor to receive government subsidies for private insurance yet too “rich” to be currently covered under existing state Medicaid programs – “rich” in quotation marks, because in many states the threshold for Medicaid coverage is ridiculously low. In Alabama, for example, (a state that rejects Medicaid expansion) a three-person family making more than $3,616 a year – just over $300 a month – is considered ineligible for coverage.
Due to a combination of low minimum-wage policies and incredibly low Medicaid wage cutoffs, many people who fall into this coverage gap are working full-time jobs. According to a study from FamiliesUSA, 57 percent of uncovered adults in states that haven’t expanded Medicaid are working. In 16 of the states that have decided not to expand Medicaid, a single parent with two kids working a full-time, minimum wage job falls into the coverage gap.
While expansion seems common sense, Republicans have opposed anything having to do with Obamacare. Alaska's Gov. Walker had first tried to get Medicaid expansion legislation passed through the Republican-controlled Alaskan House and Senate, but it never even received a committee vote. They retaliated by including language in the state budget banning Medicaid expansion, although this was widely regarded as unconstitutional.
Alaska joins three other states that have achieved expansion through executive authority alone, the others being Kentucky, West Virginia, and Ohio. However, in each state this move was only possible because state law explicitly allowed it. Obama continues to actively push for the 19 holdouts to accept Medicaid expansion, although movement has been slow.
Health care is a right, not a privilege. While Obamacare has extended affordable health care to 16 million previously uninsured Americans, our work is not done until every person in America has health insurance. Presidential candidates must make noise about the economic and moral wrongs of inaction, and we need to keep up the pressure of state legislatures and governors until every state expands Medicaid coverage.