States That Fail to Expand Medicaid Need to Get in the Game

LeeAnn Hall

Six years after the Affordable Care Act became law and gave states the opportunity to expand Medicaid to low-income residents at no cost, 19 states still stubbornly refuse to play ball and take advantage of the offer.

Medicaid expansion provides health insurance for people who earn too much to qualify for Medicaid, but not enough to qualify for ACA marketplace subsidies or afford premiums and deductibles on their own.

Now it turns out, according to a new report by the Department of Health and Human Services, marketplace premiums are substantially higher in states that failed to expand Medicaid – about 7 percent higher. Strike one.

Some 3.7 million people still don’t have access to health care because of their state lawmakers’ refusal to expand Medicaid. Nearly 90 percent of those in the health care coverage gap live in the South, and they are disproportionately people of color.

This rejection of Medicaid expansion is cruel – and steeped in racial injustice. Now that stubbornness is coming back to haunt those states.

Margot Sanger-Katz of The New York Times writes:

“The Obama administration for years has been pleading with states to expand their Medicaid programs and offer health coverage to low-income people. Now it has a further argument in its favor: Expansion of Medicaid could lower insurance prices for everyone else.

“A new study published by in-house researchers at the Department of Health and Human Services compared places that have expanded their Medicaid programs as part of Obamacare with neighboring places that have not. They found that, in 2015, insurance in the marketplace for middle-income people cost less in the places that had expanded Medicaid.”

It’s time these states stop dragging their feet and get in the game.

Medicaid expansion provides health insurance for people who earn too much to qualify for Medicaid, but not enough to qualify for ACA marketplace subsidies or afford premiums and deductibles on their own.

Billions of dollars in federal funding were put in play in the Affordable Care Act for legislators to extend health care to everyone in their states. The money not only helps people in the coverage gap afford medical care; it also strengthens the health care system for everyone by providing money for infrastructure.

According to Fitch Ratings, nonprofit hospitals and health care systems in expanding states have seen benefits from the infusion of funds. On the other hand, there’s been a clear negative impact on hospitals in non-expanding states. States that opt out of expansion have put their hospitals at a troubling disadvantage. Strike two.

If that’s not enough, even New Jersey Gov. Chris Christie, at a press conference Monday, called Medicaid expansion “a good thing.” New Jersey expanded Medicaid in 2013.

“There were many naysayers, both inside the state and around the country, who criticized that choice,” Christie said. “They were wrong then, and they’re proven wrong now.”

How wrong? The right-wing Heritage Foundation claimed that accepting the Medicaid expansion would cost New Jersey more than $1.2 billion over a 10-year period. “In fact, it’s saving the people of New Jersey money,” Christie said – an estimated $500 million a year, according to state legislators.

Through the end of this year, the ACA covers the full cost of Medicaid expansion. Starting next year, states pick up 5 percent of the cost, and by 2020, states will be responsible for 10 percent. States not participating are on their own. Strike three.

Let’s check the scoreboard: Resident of states that failed to accept the Medicaid expansion are paying higher insurance premiums in their state marketplaces. The states themselves missed out on millions of dollars each year to improve their hospitals and other health facilities. And they missed out on years of free money for health care for their residents.

In baseball, that’s three strikes – and you’re out. Health care isn’t a game. These states need to step up and expand Medicaid now, and give everyone a chance for affordable health care.

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