As we discussed yesterday, the next health care fight will need to be at the state level, where state legislators and governors will have the option to accept or turn down funding for a major expansion of Medicaid. This expansion is a major piece of how the Affordable Care Act expands coverage, so this is a critical question.
The Kaiser Foundation has been keeping track of which governors are claiming that they’ll just flat-out refuse the Medicaid expansion and the federal funding that comes with it. They’ve done the math, and in the states where governors like Scott Walker and Rick Scott have refused, an estimated 1.4 million people will go without coverage as a result. That’s a shocking number of people to be denied coverage over a policy choice made mostly out of spite.
Think Progress has a great graphic showing where different states stand on the question of Medicaid expansion. Many Republican governors have been rushing to declare that they’ll deny the expansion. Yesterday, for instance, Iowa Gov. Terry Branstad promised to “fight it in every way we can.”
This provision is already increasing coverage. Five states and the District of Columbia have already taken the Affordable Care Act’s Medicaid expansion—and more than 500,000 people now have coverage as a result. Meanwhile in Texas, with a huge uninsured population, the Medicaid expansion is in doubt.
There are other ways that Republican governors can throw a wrench into the implementation of the Affordable Care Act. For instance, they can refuse to set up the exchanges, which are the marketplaces in which people are going to be able to buy insurance.
It is worth noting that this isn’t really about budget impact. Jonathan Cohn notes that the costs to states are negligible for the first few years and small thereafter, while the effect of the Medicaid expansion on a state’s poorest people—and its hospitals and doctors—is large. Nevertheless, he worries that a combination of “fanatical devotion to anti-government philosophy [and] cold indifference to their most vulnerable constituents” will lead these governors to follow through on their threats.
Among the thousands of people we visit every week, health care is a major concern. And they understand how important it is for everyone to have access to affordable health coverage. For these governors and their allies in Washington, however, Sen. Mitch McConnell summed it up this weekend: 30 million uninsured people are “not the issue.” They just don’t think that it’s the government’s job to worry about it.
We need to make sure they know that, indeed, making sure everyone has health care is their job, and they need to get to work.