Twenty-two states are currently denying healthcare coverage to nearly seven million Americans. The intransigent opposition to the Affordable Care Act from state leadership, primarily in the South and Midwest, has unfairly burdened their residents and created a missed opportunity. Regardless of one’s opinion on other components of the ACA, the economic and social arguments for Medicaid expansion are overwhelmingly positive.
In 2012, the Supreme Court ruled that coercing states to expand Medicaid under the ACA was illegal. Because of this ruling, states have had the option to receive federal dollars to cover their low-income residents. Currently, 28 states and the District of Columbia have opted-in. The states that have refused to expand Medicaid are denying their residents basic healthcare and are harming their state economies in the process. Medicaid expansion opponents argue expansion would cripple state budgets and create further dependence on governmental programs. This post argues otherwise.
Medicaid expansion is good economics. Independent analysts have estimated a savings of over $101 billion dollars from uncompensated care if Medicaid is expanded. The reason is obvious: sick people need healthcare. If a sick person is not covered, someone else picks up the tab. Hospitals have done this for years, passing the bill on to the insured or to local governments. In addition, coverage increases primary care, which often prevents illnesses from progressing, thereby preventing more expensive care. And with federal Medicaid dollars pouring in to states, new spending stimulates growth. For residents in states that have not expanded, their tax dollars are going to the federal government, but being sent to other states that have expanded. That is a bitter pill to swallow.
Medicaid expansion will promote economic security, specifically for working families. Prior to the ACA, if an uninsured family member became sick, the lack of coverage would often bankrupt and de-stabilize the family. In fact, the most bankruptcies in America were due to illness. With expansion, poor working families or adults living alone will have the security of health coverage. This security will provide a necessary rung on the ladder of opportunity and allow families to thrive. If state legislatures are sincere about creating avenues of opportunity and rewarding hard-working families, Medicaid expansion is a great first step.
Lastly, Medicaid expansion promotes innovation in government programs. Five states have received a Section 1115 waiver from the federal government. This waiver allowed federal dollars to be spent in the healthcare marketplace, and for the state to craft innovative ideas for coverage. One such innovation has been health savings accounts, which are often supported by conservative economists as a way to increase coverage and limit healthcare costs. Expansion allows for states to try innovative solutions to address health quality, cost, and coverage. States’ rights proponents should be thrilled with the opportunities for our laboratories of democracy.
From Chambers of Commerce to hospital organizations, broad coalitions of organizations have realized that Medicaid expansion is not only good for individuals and working families, but it is good for the states. State legislatures need to rise above their personal disagreements with the ACA and expand Medicaid for their residents. As Governor Mead of Wyoming, a fierce opponent of the ACA, stated, “I don’t think we can just sit here and do nothing.”  Governor Mead, I agree.