States Begin Reacting to Health Reform’s Expansion to Medicaid
About a week ago, the Supreme Court voted to uphold the Affordable Care Act. Much attention was focused on the individual health insurance mandate, which was kept intact as a tax.
One major provision of the law was weakened, though: a set of expansions to eligibility for Medicaid, the federally-supported, state-administered health insurance program for low-income individuals and other groups. Originally, states were required to broaden eligibility for the program to include all adults with incomes up to 133% of the federal poverty level, or risk losing their federal funding for Medicaid. According to the Supreme Court, however, the federal government could not tie existing funds to the new eligibility rules – only new funds. This means, essentially, that states can choose whether or not to expand their Medicaid programs.
Between 2014 and 2016, states that do expand eligibility will receive 100% of the funding needed to do so from the federal government. Between 2017 and 2020, that percentage will slowly decrease to 90%, where it will remain for the foreseeable future.
In the week or so since the ruling, states have started to make their decisions on Medicaid expansion. According to an interactive map and commentary by Maura Calsyn and Emily Oshima of the Center for American Progress, 12 states (California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, New York, Oregon, Rhode Island, Vermont, and Washington) have committed to expanding eligibility and 7 states (Florida, Iowa, Kansas, Louisiana, Nebraska, South Carolina, and Wisconsin) have declined the extra funding. The remaining states and the District of Columbia have yet to decide.
Originally, when states were required to expand Medicaid eligibility, an estimated 17 million people would gain insurance coverage in the next ten years. Now, that number depends on each state’s decision on this issue.
According to an article by Phil Galewitz of Kaiser Health News, Medicaid expansion is already becoming a campaign issue in upcoming gubernatorial elections. Eleven states will be electing a governor this year, and in states where a Democrat has a chance to win, the health law and its impact on Medicaid are likely to play a role.