A study by the Kaiser Family Foundation conducted two years shows that all states would see significant reductions in their uninsured populations because of Obamacare’s Medicaid expansion, at almost no cost to state budgets. But the effect would be particularly dramatic in southern states with low Medicaid participation — the conservative states most likely to opt out of the expansion in the wake of the Supreme Court’s decision.
The Kaiser study is taking on new significance in showing the stakes involved for uninsured Americans as states now decide whether to accept the Medicaid expansion. The Supreme Court’s decision last week in the health care reform case barred the federal government from withdrawing all Medicaid funding from states that refuse the expansion, prompting a number of Republican governors to declare their intentions not to accept it. As TPM previously noted, states with large uninsured populations are among the most hostile to the Affordable Care Act, and the most likely sources of resistance to the law’s now-optional Medicaid expansion.
Most southern states would see their adult uninsured populations drop by about 50 percent because of the expansions — notably higher than many northeastern states that already have either generous Medicaid provisions or, in the case of Massachusetts, an existing universal health care law.
Depending on how aggressively the expansion were implemented, South Carolina would likely see a 56.4 - 76.2 percent reduction in uninsured adults. In Louisiana, the range is 50.7 - 74.8 percent. Even states like Iowa and Wisconsin — states with relatively small uninsured populations but with conservative governors threatening to thwart the ACA — the effect is striking.
In Iowa, the Medicaid expansion would likely result in a 44.1 - 69.6 percent reduction. In Wisconsin, 50.6 - 74.3.
If these states follow through with refusing the expansion, many of these people will wind up buying insurance on the exchanges — so they’re not being completely cast aside by their governors. But many will not, and the states threatening to opt out of the Medicaid expansion will also likely resist efforts to set up the exchanges themselves.
Brian Beutler is TPM's senior congressional reporter. Since 2009, he's led coverage of health care reform, Wall Street reform, taxes, the GOP budget, the government shutdown fight, and the debt limit fight. He can be reached at email@example.com.