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Will States Take Full Advantage of Health Reform?

With the election decided, it’s clear that health reform — the Affordable Care Act — is here to stay.  One of its key provisions enables states to expand Medicaid to cover low-income adults with incomes up to 133 percent of the poverty line, with the federal government paying nearly all of the cost.  The question now is whether some states will squander this opportunity to cover millions of uninsured Americans.

Coverage for more than 11 million poor, uninsured adults is at risk if states don’t expand Medicaid, according to the Urban Institute.


The Congressional Budget Office estimates that if all states adopt the expansion, they will spend only 2.8 percent more on Medicaid from 2014 to 2022 than they would have spent without health reform.  And that estimate doesn’t account for the ways in which expanding Medicaid will save states money, such as by cutting the cost of treating uninsured residents in emergency rooms and health clinics.

While governors in Florida, Texas, Louisiana, and several other states have said they’ll reject the Medicaid expansion, most states are either moving forward or their governors remain undecided, as this map shows.  In many of the latter states, governors had said that they wanted to wait until after the election to decide.

Now that we know the expansion will proceed, undecided governors should move ahead and governors who have opposed it should reconsider.