In the wake of the Supreme Court’s decision on the Affordable Care Act, which upheld the individual healthcare mandate but stipulated that states could not be compelled to expand their Medicaid rolls, Republican governors have begun announcing that they will opt out of the Medicaid expansion.
Under the original law, states that did not increase their Medicaid rolls would have all federal funding pulled for the state’s Medicaid programs. The Court ruled that this provision was unconstitutional, with Chief Justice Roberts characterizing it as “a gun to the head” of the states.
Following that decision, seven Republican governors have stated they will reject Medicaid expansion, with another eight states (seven of which have Republican governors) leaning towards rejection as well.
On Monday, Gov. Rick Perry (R-TX) announced that Texas would not implement the Medicaid expansion, saying, “I will not be party to socializing healthcare and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government.”
Under the law, the federal government would in fact fund 100 percent of the cost to expand Medicaid until 2016. By 2020, Washington will still be paying 90 percent of the expansion. According to the Center on Budget and Policy Priorities, by 2022 the federal government will pay $931 billion of the Medicaid expansion, with the states only paying $73 billion Robin Rudowitz, Associate Director for the Kaiser Commission on Medicaid and the Uninsured, noted in an interview with The Hill that despite governors’ ideological leanings, it may be difficult for states to continue saying no to that much federal funding. “States have a lot to consider,” Rudowitz said. “Tat is a lot of federal money sitting on the table.”
Though governors are presumably banking on the decision proving popular to some segments of their constituencies, the decision may also be difficult to explain to larg numbers of voters who would have benefited from the Medicaid expansion. According to the Urban Institute, two of the states that would have benefited most from the expansion, Texas and Florida, would have respectively seen 1.8 and 1.3 million uninsured people added to Medicaid rolls. Both of these states have already rejected implementation.
While much of the attention of the Supreme Court decision has focused on the individual mandate, the Medicaid decision is a huge blow to the Affordable Care Act. The original expansion would have been added 17 million uninsured Americans to Medicaid rolls. In the estimates for how many uninsured Americans would benefit from the Affordable Care Act, about half of those were expected to receive insurance through from the Medicaid expansion. Without this.
However, while the expansion has lost its teeth, it narrowly escaped being adjudicated out of existence entirely. According to Helping You Care, Chief Justice Roberts held the decisive vote on Medicaid expansion. While Justices Alito, Thomas, Scalia, and Kennedy all supported striking down the expansion, Roberts advocated for making it optional. Had they not compromised, the expansion would have died.