Some States Recognize How Much They Stand to Gain By Expanding Medicaid

While most pundits focus on the governors who are refusing Medicaid dollars, Health Access Blog’s Anthony Wright highlights five states that have gone ahead and expanded the program without waiting for 2014.  

The Affordable Care Act gave states the option of starting early and California, Connecticut, Minnesota, New Jersey and Washington and the District of Columbia all have done just that. Already, they have extended coverage to some 500,000 low-income Americans. 

“California is a leader in maximizing the benefits of the law,” says Wright, offering the map below to explain why.

map of uninsured (click to see map)

“Californians are more likely to be uninsured than residents of most other states–less likely to get coverage at work, less likely to afford coverage as an individual, more likely to be denied for a pre-existing condition,”  Wright explains. Indeed, “there are only a handful of states that are worse off.” (Census Bureau stats put California 6th or 7th from bottom.)”

Among the states in which 18% to 25% of the population is uninsured, “California is the only one aggressively taking advantage of the benefits of the law to address these problems,” he adds. “On the map, virtually all the other dozen states with well-above-average uninsured rates are currently led by Republican Governors reluctant or antagonistic to ‘Obamacare.’”  Yet, precisely because they have so many uninsured, these are the states that would gain the most if they embraced the program.

Perhaps someone should explain to the citizens of  Texas and Florida that since the federal government is paying 50% of the cost of this early expansion (and 100% beginning in 2014, 90% thereafter), their federal tax dollars are being used to provide healthcare for low-income Americans in California and Minnesota. In those states federal Medicaid dollars will also be creating jobs as hospitals, lab and nursing homes hire more workers to care for the newly-insured.

In the end, states that agree to open up Medicaid to millions of new enrollees “may actually save money” explains Ezekiel Emanuel.  In a recent New York Times Op-ed Emanuel  points to “a September 2009 report by the Council of Economic Advisers,” which observes that states (and state taxpayers) “currently pay for the uninsured in two ways. First, there is the hidden cost shift. Insurance premiums are higher for state workers (and for others whose employers cover them) because of the uninsured. Second, many states pay for uncompensated care at public hospitals and clinics. While states may have to pay 10 percent of the Medicaid expansion in 2020, they will save money from eliminating the cost shift and the uncompensated care.”

California, for example, is expected to shell out “about $195 million for expanding Medicaid when the federal government pays 90 percent in 2020.” But, the Council projects that  “it would save more than $210 million in reduced state employee premiums and more than $2 billion in uncompensated care for a net savings of more than $2 billion.  


Note to readers: I published this post yesterday on  To read the rest of the post click here.


One thought on “Some States Recognize How Much They Stand to Gain By Expanding Medicaid

  1. I live in Illinois. I think the reason the Gov. has bipassed (for now) this issue is that we are so in debt. Many IL residents don’t get the benefits of the expansion. Our dilema is that there needs to be more preventitive care programs for low income retirees! But how are we going to pay for it?