A key pillar to the Affordable Care Act was the expansion of Medicaid to cover people with income of up to 138% of the Federal Poverty Level. 94% of this expansion of Medicaid is currently funded by the Federal Government with just 6% paid by the states. Over the next two years, the State contribution will increase to 10% and stay at that level going forward, which will still leave the Federal Government covering 90% of the cost. Unfortunately, the Supreme Court ruled in 2012 that states could opt out of this Medicaid expansion, and several states with Republican Governors have chosen to opt out.
Because the Federal Government is picking up at least 90% of the cost, the residents of states who have chosen not to expand Medicaid are essentially subsidizing the states who have expanded Medicaid, as none of the portion of taxes they pay for Medicaid expansion is coming back to their state. In many cases, states who have chosen not to expand Medicaid are foregoing potentially billions of dollars.
States that have expanded Medicaid are also seeing better access to care, utilization of services, affordability of care, and financial security.
Most importantly, the failure of states to expand Medicaid has resulted in millions of people remaining uninsured because they do not qualify for Medicaid or for Affordable Care Act marketplace subsidies, falling in what has become known as the coverage gap.
Yet, several states still refuse to expand Medicaid. Why? Because the Medicaid expansion is part of Obamacare, and Republican politicians have spent eight years demonizing Obamacare. These Republican politicians would rather say no to better outcomes for their constituents than admit they were wrong.
The good news is that in four of these states, there are currently competitive gubernatorial elections, which if won by the Democratic nominee, could lead to Medicaid expansion, and the better outcomes that have followed for the people of the states that have expanded Medicaid. And if the Democratic nominees were to win in just these four states, close to a million uninsured people could get access to healthcare through Medicaid expansion.
The states and potential people who could be helped are detailed in the below study from the Kaiser Family Foundation:
|State||Number in Coverage Gap||Share in the Coverage Gap Who Are:|
|People of Color||Adults Without
|Female||In a Working Family|
|All States Not Expanding Medicaid||2,223,000||53%||77%||48%||61%|
|NOTES: * Wisconsin provides Medicaid eligibility to adults up to the poverty level under a Medicaid waiver. As a result, there is no one in the coverage gap in Wisconsin. Totals may not sum due to rounding. N/A: Sample size too small for reliable estimate.|
The states with competitive races for Governor this year are:
Florida – 384,000 uninsured people could gain access to health care. The Democratic nominee for Governor, Andrew Gillum, currently leads in aggregate polling, and has stated his support for expanding Medicaid, while his opponent has stated his opposition.
Georgia – 240,000 uninsured people could gain access to health care. The Democratic nominee for Governor, Stacey Abrams, is currently basically even in aggregate polling, and has stated her support for expanding Medicaid, while her opponent has stated his opposition.
Kansas – 48,000 uninsured people could gain access to health care. The Democratic nominee for Governor, Laura Kelly, is currently basically even in aggregate polling, and has stated her support for expanding Medicaid, while her opponent has stated his opposition.
Oklahoma – 84,000 uninsured people could gain access to health care. The Democratic nominee for Governor, Drew Edmondson, is currently polling slightly behind but within the margin of error, and has stated his support for expanding Medicaid, while his opponent has stated his opposition.
The elections of Democrats Andrew Gillum in Florida, Stacey Abrams in Georgia, Laura Kelly in Kansas, and Drew Edmondson in Oklahoma could literally be a matter of life over death for nearly a million people.