Are Republican Governors Pushing Back on Medicaid Expansion?

By doing so, millions of poor Americans will remain uninsured. 

Posted: 09/24/2012 11:32 AM EDT

A major goal of President Obama’s Affordable Care Act (ACA) is a simple one: Lessen health disparities in this country by expanding health care coverage to the 30 million Americans who are not insured. And better access to health care is incredibly important for African-Americans, given that 21 percent of us were uninsured in 2009 and 20 percent of us do not see a doctor regularly. Plus, we are more likely to be diagnosed and die of a range of diseases, such as cancer and AIDS.

One way that the Affordable Care Act will achieve insuring the uninsured is by expanding eligibility for Medicaid, a government-issued insurance for low-income and disabled Americans, to even more people who cannot afford health insurance. Medicaid eligibility rules are different in each state, according to HealthDay. And in many states, “low-income, non-disabled adults who aren't pregnant or don't have dependent children can't qualify for Medicaid coverage. Few states cover non-disabled parents at or above 100 percent of the federal poverty level — currently $19,090 for a family of three.”

But in 2014, under the Affordable Care Act, the new eligibility rules will cover people 64 and under who are living 133 percent below the poverty line. Translation: A single person making $15,415 a year or a family of four that earns only $31,809 could get Medicaid.

For millions, this is great news. But there is a catch.

This expansion will not happen if the states do not agree to it. Congress cannot force them. Under the Affordable Care Act rules, the federal government will pay 100 percent of the cost for expansion for three years and after that, they will contribute only 90 percent moving forward. State governments will have to make space in their budgets to cover the cost.

But factor this in: On average, the federal government pays for 57 percent of Medicaid costs and states pick up the rest. This could cost states millions more each year. And for some states that are already in the midst of a budget crisis now, finding the extra money must seem daunting.

HealthDay also reported that some states have already stated that they won’t expand it, but it might be for political reasons:

Republican governors in Florida, Iowa, Kansas, Louisiana, Nebraska, South Carolina and Wisconsin indicated that they have no intention of expanding Medicaid, according to a July tally by The Hill's HealthWatch blog. Eight other governors, including one Democrat, are leaning against expanding their state Medicaid programs, and 22 states, including seven with Democratic governors, remain undecided, according to that report….

Many believe states' rejection of the Medicaid expansion is driven largely by election-year politics.

"This is a way in which they're signaling continuing opposition to the Affordable Care Act," said Leighton Ku, professor and director of the Center for Health Policy Research at George Washington University.

Because of this pushback, it’s now estimated that only 9 million more people will be enrolled in Medicaid by the year 2020, instead of the 15 million that was once believed would be insured.

African-Americans are deeply affected by how this Medicaid expansion pans out. Not only are we disproportionately poor and uninsured, but so many of us currently are dependent on Medicaid. In 2009, the Kaiser Family Foundation reports, 27 percent of African-Americans — 10 million people, including 6 million children — were covered by Medicaid [PDF].

 

To learn more about the Affordable Care Act Medicaid Expansion, go here.

 

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 (Photo: Justin Sullivan/Getty Images)

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