There appears to be no clear consensus among U.S. governors regarding the Medicaid expansion as called for in the Affordable Care Act (ACA)—which could deeply affect the future of the U.S. health care system, according to a Harvard School of Public Health (HSPH) perspective article appearing in the January 16, 2013 New England Journal of Medicine.
States must decide before January 1, 2014, when the ACA’s most sweeping reforms take effect, whether or not to participate in the expansion of Medicaid eligibility to all adults with family incomes at or below 138% of the federal poverty level. States that opt to participate would pay less than 10% of the cost.
Co-authors Benjamin Sommers, assistant professor of health policy and economics in the Department of Health Policy and Management, and Arnold Epstein, chair of the department and John H. Foster Professor of Health Policy and Management, took an in-depth look at the views expressed by governors about Medicaid expansion from June 2012, when the Supreme Court upheld the health care law, through one month after the November 2012 presidential election. While governors don’t necessarily have the final say about Medicaid expansion in their states, the researchers noted, they do oversee their states’ Medicaid programs and often set the terms of debate with their state legislatures.
The authors found that 17 governors are still undecided about expanding Medicaid and well under half support the expansion. Among those opposed or undecided—mostly Republican governors—the biggest concern is that Medicaid expansion will cost their states too much. Others have issues with the Medicaid program itself, calling it “broken.”
“It now appears that the ACA’s 2014 coverage expansion will have large unintended gaps, as low-income adults in at least a dozen states remain ineligible for any kind of public subsidy for health insurance,” Sommers and Epstein wrote.