On Thursday, Utah Gov. Gary Herbert (R) became the latest Republican to embrace Obamacare’s Medicaid expansion, according to the Salt Lake Tribune. “Doing nothing … I’ve taken off the table,” said Herbert during a news conference announcing the decision. “Doing nothing is not an option.”
About 15 percent of Utah residents are uninsured. But among adults who earn up to 138 percent of the Federal Poverty Level (FPL) — the threshold for Medicaid eligibility in states that choose to expand it — the uninsurance rate rises to almost 40 percent. Medicaid expansion is expected to cut that uninsurance rate in less than half and extend health benefits to 111,000 of the state’s poorest.
While Herbert said his administration still needs to determine exactly how the Medicaid expansion will be implemented, reports indicate that the Utah legislature is inching towards an alternative model similar to the one that the Obama administration approved for Arkansas last fall. This iteration of Medicaid expansion would give low-income Americans subsidies to buy private plans through Obamacare’s marketplaces and would need federal approval. The model has already proven to be successful in Arkansas.
Other Republican-led states skeptical of Obamacare and hesitant to expand Medicaid, a public program conservatives have historically criticized, are likely to follow suit. Iowa received approval for a more conservative version of the Arkansas “private option” in December. Pennsylvania Gov. Tom Corbett (R) has submitted his own alternative model (albeit one that has been sharply criticized for putting too many burdens on the poor). There have been whispers that GOP governors in Tennessee, Texas, and Louisiana may eventually come around to the private option.
In red states, knee-jerk opposition to Obamacare has clashed with the reality that millions of low-income residents are being forced to fend for themselves while hospitals that primarily serve the poor can’t afford to keep treating uninsured patients in perpetuity. At least five public hospitals have been shuttered in anti-expansion states like Georgia, North Carolina, and Virginia, with more closures and staffing cuts on the horizon. Poor and sick people who relied on these hospitals will have to journey as far as 40 miles for their medical care now.
Taxpayers in these states are also getting a raw deal since their tax dollars will be used to fund other states’ Medicaid expansions. A recent study by the Commonwealth Fund found that rejecting the expansion will cost taxpayers billions. Some experts believe that a perfect storm of pressure from hospitals, advocates for the poor, and taxpayers themselves will nudge conservative states towards embracing the expansion.
“Your average taxpayer is saving zero dollars by not expanding,” explained Sean Nicholson, professor of policy analysis at Cornell University, in an interview with USA Today. “It seems very difficult for a governor to explain to an educated voter why they’re disadvantaging the poorest people in the state — and subsidizing some people who are richer than they are.”
“I’m actually surprised that so many (states) went into 2014 without [expanding Medicaid],” added Gail Wilensky, former Medicaid director for President George H.W. Bush.
To date, 26 states and the District of Columbia have embraced Medicaid expansion. Another three are still considering the expansion while 21 states have rejected it outright. A state can choose to expand Medicaid at any point during the legislative year.