The Affordable Care Act expands Medicaid coverage to more low-income Americans, but a Supreme Court decision made that expansion optional for states -- and many in the South are opting out.

Southern states stand to lose out on billions of dollars by blocking Medicaid expansion

The 20 states refusing to expand Medicaid coverage to more low-income residents under the Affordable Care Act (ACA) will forgo billions of dollars in federal funds -- but their residents will still help pay for the cost of other states' expansions through federal taxes.

The Commonwealth Fund, a New York-based health policy think tank, has calculated the net loss to states blocking expansion -- and it turns out that the biggest losers are all in the South.

The five states with the highest estimated net losses are Texas at $9.2 billion, Florida at $5 billion, Georgia at $2.9 billion, Virginia at $2.8 billion, and North Carolina at $2.6 billion.

"No state that declines to expand the program is going to be fiscally better off because of it," says Sherry Giled, co-author of the study with Stephanie Ma. "Their tax dollars will be used to support a program from which nobody in their state will benefit."

The other 15 states that have refused to expand Medicaid are Alabama, Alaska, Idaho, Kansas, Louisiana, Maine, Mississippi, Missouri, Nebraska, Oklahoma, South Carolina, South Dakota, Utah, Wisconsin and Wyoming.

Under the ACA, the federal government pays 100 percent of the total cost of expanding Medicaid to residents with incomes at or below 138 percent of the federal poverty level through 2016. (Prior to ACA, Medicaid coverage for low-income adults was very limited.) The federal contribution for the expansion will drop from 100 percent to 90 percent by 2020 and stay at that level. But a 2012 Supreme Court ruling that upheld the constitutionality of the ACA also made expanding Medicaid voluntary for the states.

Efforts are underway to get states that have declined Medicaid expansion to reconsider. In North Carolina, for example, Moral Monday activists are calling on Gov. Pat McCrory (R) to convene a "Special Redemption Session" of the legislature to revisit Medicaid expansion, though McCrory has said such a session is "out of the question." This week, the White House joined in the chorus asking North Carolina leaders to reconsider, with spokesperson Josh Earnest joining in a news conference on the matter and calling Medicaid expansion "a smart choice for states."

"Our residents are really missing out on an opportunity here," said Durham, N.C. Mayor Bill Bell during the news conference. "By not participating, North Carolina's just becoming a donor state."

Also this week, the Obama administration released a brief on the benefits Medicaid expansion would bring to African Americans. It notes that under ACA, 6.8 million uninsured African Americans would be eligible to access new options for health coverage next year. Of that number, 2 million would qualify for Medicaid or the Children's Health Insurance Program.

The brief also documented the five states with the greatest number of uninsured African Americans eligible for help under ACA. They are Florida with 10 percent of all eligible uninsured African Americans, Georgia and Texas with 9 percent each, North Carolina with 6 percent, and New York with 5 percent. Among those five states, New York is the only one expanding Medicaid.

Commonwealth Fund President Dr. David Blumenthal said that, in light of the billions of dollars states will lose by rejecting Medicaid expansion and the fact that millions of their most vulnerable resident won't be able to get health insurance as a result, "it seems likely that non-expanding states will face increasing pressure over time to reconsider their decisions."

The Affordable Care Act expands Medicaid coverage to more low-income Americans, but a Supreme Court decision made that expansion optional for states -- and many in the South are opting out.
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No Medicaid will cost state taxpayers doubly

Here in Texas Gov. Perry is absolutely refusing to accept the Medicaid portion of the ACA and it really pisses me off. Putting aside the morality and ethics of this decision, Perry pretends to be fiscally conservative and now he is doing something that is going to cost Texas taxpayers and health insurance premium payers through the nose. The millions who would qualify for this program because we are so stingy already with our requirements for the current Medicaid, will continue to use the ER as the last ditch effort to get care when they are so sick that they are forced to go. What will that mean? It means instead of paying $50 for a doctor visit and maybe $20 to $75 for a prescription, there now is the potential for an extended inpatient stay possibly including time in an ICU. Some one has to pay for that. Just as we do now it will come out of the county budget, the hospital budget, our Hospital Real Estate taxes, etc. And as it is now, that means all the insureds in TX will see higher premiums because hospitals and other medical providers have to make up those costs. Now you have a worker (and almost all of these people do have jobs) who is not being productive, lost wages, lost buying power and possibly partial or total disability. Add to that the money we will send to the other states who are wisely setting up their Medicaid programs. These guys (and most of the decision makers in this state are guys) aren't fiscally conservative. They are 3 year olds who would rather cut their (our) noses off to spite themselves because they didn't get their way with stopping Obama's healthcare plan.

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