Failure to Expand Medicaid Is a Missed Opportunity

If all states expanded Medicaid, 651,000 people would receive all the care they feel they need

The White House Council of Economic Advisers has released a new report finding that the failure of 24 states to expand Medicaid has serious consequences for their uninsured residents.

The report, which cites data from the Urban Institute, finds that 5.7 million Americans will be left without health insurance by 2016 if current patterns do not change. Furthermore, states refusing to expand Medicaid will forego billions of federal dollars that would otherwise boost their economies, create jobs, and achieve savings in health-care costs.

Looking at the numbers, in the 24 states that haven’t expanded Medicaid there are roughly 32 percent more people who would qualify for insurance coverage under the expansion than in the 26 states that have expanded. As such, the report finds that if all states expanded Medicaid, 651,000 people would receive all the care they feel they need in a given year (in addition to the 494,000 who will do so under the status quo); 810,000 fewer people would have trouble paying other bills due to medical costs (in addition to the 614,000 people in states that have already expanded Medicaid); and an additional 559,000 women would be able to get either mammograms or Pap smears (in addition to the 422,000 who can already access these preventive reproductive health procedures).

Despite arguments from conservative state governors who say expanding Medicaid would be fiscally irresponsible, the report says that Medicaid expansion will more than pay for itself. States that have already expanded Medicaid will create an additional $62 billion in total economic activity through 2017, and will save $10 billion over ten years in reduced uncompensated care that is currently financed by state governments.

Expanding Medicaid primarily affects low-income adults by raising the eligibility level for Medicaid to 133 percent of the federal poverty level (FPL). Before the Affordable Care Act was passed, non-disabled adults with no children almost never qualified, working parents qualified at a median income of 61 percent of the FPL, and children usually qualified either for Medicaid or the Children’s Health Insurance Program.

Because the Supreme Court ruled that states could not be forced to expand Medicaid, there is a “coverage gap” for adults living in states that refuse expansion and making between 100 and 133 percent of the FPL. They can neither qualify for Medicaid nor receive subsidies on the Affordable Care Act’s insurance exchanges.

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