The media have focused on the recent Affordable Care Act (ACA) deadline for states to decide whether they will create health insurance exchanges. It’s an important issue, but if a state does not agree to build an exchange, the federal government will step in and create one. So either way, all 50 states will end up having health insurance exchanges.
But the other ACA choice that states have to make is whether to expand Medicaid in their states to include more beneficiaries. According to the ACA law, states will not have pay for the expansion until later years:
States that refuse to cover more poor people will do so despite the fact that Uncle Sam will pick up most of the tab. From 2014 to 2016, the federal government will pay 100 percent of the cost of covering newly eligible people, after which the share will gradually go down to 90 percent in 2022 and later years.
So what is stopping the eight states whose governors have declared that they will not expand Medicaid? Oklahoma’s Governor Mary Fallin makes her case (emphasis mine):
“I have also decided that Oklahoma will not be participating in the Obama Administration’s proposed expansion of Medicaid. Such an expansion would be unaffordable,” Fallin said. Oklahoma and seven other states have declared they won’t expand Medicaid to their poorest residents[.]