Even though the expansion of Medicaid to cover several million more low-income Americans isn’t slated to begin until January 2014 — and even though states aren’t scheduled to begin contributing anything to the expansion until 2016 — some states have already declared their intention to not take part in the program.
Not surprisingly, Florida, which led the charge in the 26-state lawsuit to strike down the Affordable Care Act, was the first one out of the gate to issue an official statement.
“Floridians are interested in jobs and economic growth, a quality education for their children, and keeping the cost of living low,” explained Florida Governor Rick Scott. “Neither of these major provisions in ObamaCare will achieve those goals, and since Florida is legally allowed to opt out, that’s the right decision for our citizens.”
While Scott says Floridians don’t want the expansion, the Washington Post reports that 951,622 additional residents of the state — and possibly growing, depending on where the poverty line shifts — now face not being able to get Medicaid if the state opts out.
Meanwhile, South Carolina leaders have also announced the state’s intention to not take part in the expansion, leaving 330,932 people without Medicaid.
The AP reports the Mississippi is saying it can’t afford to spend $1.7 billion over the course of 10 years to pay for Medicaid to cover an additional 400,000 residents.
Missouri would add another 225,000 people to the list of the insured because of the expansion, but the state house’s majority leader tells the AP, “we’re not going to consider going down that path.”
Texas hasn’t decided yet what it’s going to do, probably because the state would need to explain to 2 million currently uninsured Texans why they won’t be covered by Medicaid expansion.
Given the amount of time between now and January 2014 — not to mention the ever-shifting political landscape — it’s all a bit too premature for anyone to be opting out of a program before it exists.
But, should Medicaid expansion come to pass — and should these states remain steadfast in their decisions to not take part — what will those uninsured people hovering around the poverty line do?
For those earning more than $11,170, the ACA allows people to use subsidies to buy insurance on the new “exchange” market (which Governor Scott also says Florida will not be involved in), but for those on the other side of that line, explains the Washington Post:
Poorer Americans—those who live below the poverty line— could be caught in a sort of “no man’s land.” They’re not eligible for subsides under health overhaul because the law worked with the assumption that they would fall under the Medicaid plan.
“States will face the reality that they will be giving up millions or billions of federal dollars and still end up with hundreds or thousands of uninsured people who will drive up health care costs for everyone else,” DeAnn Friedholm, Consumers Union’s Campaign Director of Health Care Reform, told Consumerist last week in the wake of the Supreme Court ruling that upheld the mandatory coverage portion of the ACA but struck down the law’s penalties for states that don’t comply with Medicaid expansion.