The One Argument For Medicaid Expansion That Even Republicans Have To Agree With


As a growing number of conservative states expand their Medicaid programs under the requirements of the Affordable Care Act, a new analysis finds that the states still holding out on expansion will pay out $152 billion to provide insurance for low income Americans in other states with incomes up to 138 percent of the federal poverty line.

Taxpayers in five of the biggest non-expansion states — Texas, Florida, North Carolina, Georgia and Virginia — will have to fork over close to $88 billion through federal taxes to benefit others. Under the law, the federal government picks up the entire cost of expansion through 2016 and up to 90 percent thereafter. As a result, federal dollars will pay for more than 95 percent of the total cost of the Medicaid expansion over the next ten years (from 2015 to 2024).

The findings come from a McClatchy analysis of Urban Institute data.

“Here is money that is pretty much there for the asking, and these states are turning it down. And in the meantime, their taxpayers are paying taxes that fund expansions in states that are moving forward. It just doesn’t make any sense,” Sherry Glied, the dean of the Robert F. Wagner Graduate School of Public Service at New York University, told McClatchy.


Indeed, though states must contribute their share toward the expansion, state spending is greatly offset by federal dollars. A recent analysis from the Robert Wood Johnson Foundation found that for every dollar a state spends on Medicaid expansion, it receives $13.41 in federal funding. Those federal dollars, in turn, create jobs and boost state economies. A White House report from July estimated that states that have already expanded Medicaid will create “a total of 356,000 job through 2017.”

Last week, Pennsylvania received a waiver from the federal government and became the ninth state with a Republican governor to accept federal Medicaid dollars. The GOP dominated states of Wyoming and Tennessee are also hammering out an agreement with the Obama administration that would grow their Medicaid programs.

For these governors, the case for expanding health care is one of fairness. As Gov. John Kasich’s (R-OH) Office of Health Transformation wrote on its website when announcing expansion in 2013, “It would make a bad situation far worse if Ohio does not extend Medicaid coverage and reclaim its share of federal taxes to support jobs here in Ohio — jobs that will be created in other states with our money if Ohio does not extend coverage.”