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ObamaCare Medicaid Expansion

ObamaCare’s Medicaid Could Insure 21.3 Million Americans in the Next Decade. So Why Do Some States Want to Opt-Out Of ObamaCare’s Medicaid Expansion?

ObamaCare Medicaid Expansion is one of the biggest milestones in the health care bill. ObamaCare’s Medicaid expansion expands Medicaid to our nations poorest in order cover nearly half of uninsured Americans. The law previously required states to cover their poorest or lose federal funding to Medicaid (federal funding covers 90-100% of the costs) until the supreme court ruling on ObamaCare.

States opting out of the expansion of Medicaid under ObamaCare is projected to drive up insurance costs drastically (check out the facts below), while saving the States relatively small amounts, if anything. Join the ObamaCare Facts Mailing List to keep up to date on Medicaid Expansion vote in your state.

ObamaCare MedicaidHistory of ObamaCare’s Medicaid Expansion and the NFIB

Unfortunately, when the NFIB took ObamaCare to the supreme court in order to repeal it, the Medicaid expansion requirement was overturned.

Now each state can decide whether or not they want to opt out of expanding coverage to their poorest with no penalty. The new ruling doesn’t just hurt Medicaid and ObamaCare, it affects the tax payer by forcing us to pay for states that choose not to help their poorest.

National Federation of Independent Business (NFIB) is an “independent” group that represents “small business”. However, they historically follow the Republican party line and fight against “entitlement” programs like ObamaCare’s Medicaid Expansion that help the nations poorest and the majority of smaller businesses.

Remember the only businesses that pay more under ObamaCare are the top 3% of small businesses and big business. Learn More About Small Business and ObamaCare.

Nearly ONE HALF of uninsured Americans were going to get their health insurance under ObamaCare Medicaid reform by expanding coverage to the nations’ poorest starting in 2014. Now states can opt-out without losing federal funding.

What is Medicaid?

Medicaid is a joint federal and state funded program that provides health care for over 60 million low income Americans, mostly children, people with disabilities and elderly people who need help or live in nursing homes.

Since Medicaid is a program that works partly on a state level with help from the federal government the rules alter from state to state, but the rule of thumb is that most low-income adults under 65 cannot currently receive Medicaid.

What is “Wrong” With Medicaid?

Obamacare opponents use the downfalls of Medicaid as terms to reject Medicaid Expansion. Drawbacks of Medicaid include: limited access to health care, low-end quality healthcare and coverage and low doctor payouts. Doctor payouts have been historically low (even lower than Medicare payouts, which themselves are arguably too low). Due to low payouts, many doctors don’t take Medicaid and the quality of care tends to be poor. However, ObamaCare’s Medicaid Reforms do a lot to change this.

The ObamaCare Medicaid reforms that come with ObamaCare’s Medicaid Expansion include raising the amount doctors get paid to the same level of Medicare (73%) and increasing payments to Medicaid programs that offer preventive services for free or at little cost. New free preventive services include tests for high blood pressure, diabetes, and high cholesterol; many cancer screenings, including colonoscopies and mammograms; counseling to help people lose weight, quit smoking or reduce alcohol use; routine vaccinations; flu and pneumonia shots; and other services.

The ObamaCare Medicaid Reforms

The ObamaCare Medicaid reforms were meant to expand coverage to up to 21.3 million of our nations’ poorest. The law had said, prior to the supreme court hearing, that very low-income individuals (those under the 133% FLP line) including adults without dependent children. Even though Medicaid is a federal and state joint program the funding for low income individuals was covered 93% over the next decade by the federal government using tax payer money.

Medicaid Expansion means, in all States, individuals with annual incomes up to 133% of the federal poverty line — currently, $14,856 or less — are able to enroll. Right now eligibility differs from State to State.

If a state refused to expand coverage then it would lose all of it’s Medicaid funding. This was meant as a protection to ensure that states supported their poorest equally. However, the NFIB ‘Repeal ObamaCare Effort’ worked to some extent; now states are no longer required to insure their poorest under ObamaCare, yet they can still receive the full federal funding for their Medicaid program.

States can now opt-out of Medicaid for it’s poorest without losing any federal funding.

ObamaCare Medicaid Expansion Opt-Out

The supreme court decided that states have the right to opt-out of Medicaid for it’s poorest without losing any federal funding. This may seem fair or harmless, but the implications of this are dire. This will leave many of the nations poorest without health insurance come 2014. ObamaCare Medicaid reform was meant to cover 17 million of our poorest through Medicaid and millions of higher income individuals through Medicare and the Online Health Insurance Exchange Marketplace. Now millions of people may go without health insurance.

If You Don’t Want Your State To Reject Medicaid Expansion For Your State’s Poorest. Vote For ObamaCare Supporters on A State Level.

What Are the Consequences of ObamaCare Medicaid Expansion Opt-Out?

If the states decide to Opt-Out of Medicaid expansion, ObamaCare itself will have to step up to the plate and insure these individuals via the ObamaCare Health Exchanges. The problem is that this will likely raise everyone’s health insurance, including those with private insurance.

This means that anti-ObamaCare states who reject Medicaid will not only hurt their poorest, it will affect every tax paying American and every American who has health insurance.

What if All States Moved Forward With Medicaid Expansion?

If all states move forward with ObamaCare’s Medicaid Expansion they will collectively pay $76 billion (a 3% increase) to insure up to 21.3 Million individuals who don’t have access to health insurance (about half of the nations uninsured) over the next decade. Obviously, those who have more to cover will have to spend more. Regardless of what a state spends, the Federal Government covers 93% of the States’ costs. State spending increases are relatively small compared to what States would pay without ObamaCare or to the 26% increase that the federal government will pay towards Medicaid.

Where the States Stand
ObamaCare Medicaid Expansion Facts

• The federal government will pay a very high share of new Medicaid costs in all states. 100% of costs are covered for the first year. 90% of the spending is done by federal government moving forward.

•Increases in state spending are small compared to increases in coverage and federal revenues, and relative to what states would have spent if reform had not been enacted.

• ObamaCare Medicaid Expansion sets the eligibility level for Medicaid at 133% FLP, although there is a special deduction to income equal to five percentage points of the poverty level raising the effective eligibility level to 138% of poverty.

• The legislation maintains existing income counting rules for the elderly and groups eligible through another program like foster care, low-income Medicare beneficiaries and Supplemental Security Income (SSI).

• The NFIB helped to change the Affordable Care Act to include a “state opt-out” for Medicaid Expansion.

• In combination with ObamaCare’s other provisions, if all states participate in Medicaid expansion, it would reduce the number of uninsured by 48%, relative to the number of uninsured without the ObamaCare. States with higher uninsured rates prior to the ObamaCare would see larger increases in Medicaid and bigger reductions in the uninsured, compared to states with lower pre-ObamaCare uninsured rates.

• If all states implement the expansion, an additional 21.3 million individuals could gain Medicaid coverage by 2022, a 41% increase compared to Medicaid without the ObamaCare. With many States opting out, the number is expected to fall below 15 million.

• Medicaid Expansion covers those who are most likely to use emergency services that cost hospitals tens of billions in unpaid hospital bills.

• States will spend little to nothing expanding Medicaid. For example, it would cost the State of Florida about $5 a year per person to cover all uninsured below the 138% FLP.

• Low-income families and other Americans who would be eligible for Medicaid will fall between the cracks without expansion (as they do now). ObamaCare will most likely have to insure them in the ObamaCare health exchanges. This is projected to drive up the cost of insurance for all Americans by a great deal.

•Big Business-backed groups like ALEC and the NFIB frequently suggest legislation that seeks to dismantle public programs at a state level. They tend to achieve this in Red states where they have the most pull. These states need Medicaid the most as they have the most low-income individuals falling through the cracks. They will also put a bigger burden on everyone else as it will cost more to insure their poorest on the exchange.

• If Medicaid Expansion is Opted-out of by too many states, it will greatly diminish the effectiveness and affordability of ObamaCare. Stop your state from Opting out of Medicaid by helping to share the ObamaCare Facts.

• The federal government will pay for most (90% – 100%) of the Medicaid expansion when it is implemented in 2014, but states would be required to pay for up to 10% percent of it by 2020.

• Some States, are saying that paying 0% – 10% of the Medicaid expansion as laid out under ObamaCare will cost them too much. While some States will pay more, the increase is very small (3% average increase in Medicaid Spending), even for the States who will pay the most.

• A Harvard case study found that states who had expanded their Medicaid programs from 2000 to 2005 improved health care for the state and saved thousands of lives.

• Some States are expected to save Billions from ObamaCare’s Medicaid Expansion.

Which States Will Expand Medicaid under Medicaid Expansion?

Want to know which states will insure the 15 million Americans below the poverty line and which States will leave the rest of the 21.3 million uninsured behind? Find out which states support their state’s poorest. Want more information on ObamaCare and Medicaid Expansion? Get the Full KKF Medicaid Expansion Report.


  • Alabama*: Gov. Robert Bentley (R)
  • Florida*: Gov. Rick Scott (R)
  • Georgia*: Gov. Nathan Deal (R)
  • Idaho*: Gov. C.L. Otter (R)
  • Iowa*: Gov. Terry Branstad (R)
  • Louisiana*: Gov. Bobby Jindal (R)
  • Maine*: Gov. Paul LePage (R)
  • Mississippi*: Gov. Phil Bryant (R)
  • North Carolina: Gov. Pat McCrory (R)
  • Oklahoma: Gov. Mary Fallin (R)
  • Pennsylvania*: Gov. Tom Corbett (R)
  • South Carolina*: Gov. Nikki Haley (R)
  • South Dakota: Gov. Dennis Daugaard (R)
  • Texas*: Gov. Rick Perry (R)
  • Wisconsin*: Gov. Scott Walker (R)


  • Alaska*: Gov. Sean Parnell (R)
  • Nebraska*: Gov. Dave Heineman (R)
  • Wyoming*: Gov. Matt Mead (R)


  • Kentucky: Gov. Steve Beshear (D
  • New York: Gov. Andrew Cuomo (D)

PARTICIPATING (25 states and the District of Columbia)

  • Arizona*: Gov. Jan Brewer (R)
  • Arkansas: Gov. Mike Beebe (D)
  • California: Gov. Jerry Brown (D)
  • Colorado*: Gov. John Hickenlooper (D)
  • Connecticut: Gov. Dannel Malloy (D)
  • Delaware: Gov. Jack Markell (D)
  • District of Columbia: D.C. Mayor Vincent Gray (D)
  • Hawaii: Gov. Neil Abercrombie (D)
  • Illinois: Gov. Pat Quinn (D)
  • Maryland: Gov. Martin O’Malley (D
  • Massachusetts: Gov. Deval Patrick (D)
  • Michigan*: Gov. Rick Snyder (R)
  • Minnesota: Gov. Mark Dayton (D)
  • Missouri: Gov. Jay Nixon (D)
  • Montana: Gov.-elect Steve Bullock (D)
  • Nevada*: Gov. Brian Sandoval (R)
  • New Jersey: Gov. Chris Christie (R)
  • New Hampshire: Gov. Maggie Hassan (D)
  • New Mexico: Gov. Susana Martinez (R)
  • North Dakota*: Gov. Jack Dalrymple (R)
  • Ohio*: Gov. John Kasich (R)
  • Oregon: Gov. John Kitzhaber (D)
  • Rhode Island: Gov. Lincoln Chaffee (I)
  • Vermont: Gov. Peter Shumlin (D)

indicates a state’s participation in the multistate lawsuit against ACA

Go Here For Governor’s Statements on the Medicaid Expansion

ObamaCare | Cost Of Medicaid Expansion

While states like Florida and Colorado say that a 3% increase in spending is too much, states like Michigan are showing that the States can actually save money by adopting the Medicaid expansion.

The nonprofit Center for Healthcare Research & Transformation projected the net costs of Michigan expanding Medicaid under the health system reform law. In all three scenarios of enrollment uptake assumed by the researchers, the state would reduce both overall spending and the numbers of uninsured residents. Figures represent the state’s 10-year cost savings, in millions, under moderate projections for the enrollment of newly Medicaid-eligible residents in 2014, the expansion’s first year.

$1,861 million: Reduction in non-Medicaid mental health spending

$504 million: Reduction in prisoner inpatient medical spending

$444 million: Increase in tax revenues from health facilities and professionals

$395 million: Savings from elimination of Adult Benefit Waiver program

$23 million: Reduction in state employee health spending

$3,228 million: Total state budget savings

$2,245 million: Gross state expansion costs

$983 million: Net state budget savings

Note: Savings amounts do not add up to total savings due to rounding.

Source: “The ACA’s Medicaid Expansion: Michigan Impact,” Center for Healthcare Research & Transformation, October

Who’s Eligible Under the ObamaCare Medicaid Expansion?

Eligibility for Medicaid Expansion is decided on state by state (typically under the 138% FLP mark). If you live in a state that doesn’t want to repeal ObamaCare you are probably safe, however some Red states and swing states should be worried! All legal residents who earn less than $15,302 for individuals and $31,155 for a families of four can receive Medicaid under Medicaid Expansion. People covered under the expansion also include:

• Low income adults with or without dependent children

• Low income children who lose their Medicaid benefits when they are reclassified as adults 19 years.

• Low income adults with disabilities who are not eligible for SSID or SSI.

Has Expanding Medicaid Worked Before?

New York, Arizona and Maine expanded Medicaid between 200 and 2005. A Harvard study reports, “rates of uninsured residents dropped, access to care improved, and more people reported being in very good or excellent health”. The coverage was estimated to save a total of 2,840 lives a year for the states.

Why the ObamaCare Medicaid Expansion Matters

About half of our nations’ uninsured are in danger of losing coverage on a state level. Letting states Opt-out of ObamaCare’s Medicaid drives the costs up for the rest of Americans who choose to help their poorest. It drives up our taxes and the cost of healthcare. On a human level, these low-income individuals won’t have access to healthcare and under the current law they won’t receive help in the online market place under a certain income (this makes health insurance affordable for the rest of us).

Most of all, on a “business” level, hospitals and healthcare as a whole will suffer since they will still have to care for these individuals via emergency uncompensated care which will shift even more costs back on us.

The Republican backed NFIB and the anti-ObamaCare guys had their day. Lets fight back with our votes and tell them we want ObamaCare and Medicaid for all Americans! Don’t let them use state level legislation tactics against an unsuspecting public.

States Opting Out of Medicaid for Their Poorest

The supreme court decision not to repeal ObamaCare (brought to the supreme court by NFIB) says that states can reject Medicaid for their poorest (leaving up to 7% of their states poorest uninsured).

Why would a state want to reject Medicaid? It’s because they don’t have to reject the funding, they just can opt not to funnel it to poor people. This drives the cost of health care up for the rest of the country and makes ObamaCare less effective.

Who Will Reject Medicaid?

The first states to reject ObamaCare would most likely be the Red states making the Blue states and the Federal Government to carry them on their back. This is already the case with many public programs. The irony is that these are the same states that have the majority of people who call people who receive and need Government assistance.

Big Business Vs. Medicaid Expansion

Big business pays big money to move federal programs to a state level so they can reject portions of the bill they don’t like that affect the states they operate in. They use this tactic to degrade the program as a whole and weaken it at a federal level, making them less effective. This gives legislators grounds to privatize and dismantle these programs while creating tension between the states themselves.

Moving Government programs to a state level is an age-old tactic used by Big Business under the guise of being “Libertarian or Federalist”. The true intension is to dismantle popular Government programs like Obamacare and Social Security on a state level via legislation drafted by groups like ALEC.

Protect The Expansion of Medicaid at a State Level

ObamaCare’s Medicaid expansion, if it passes in all 50 states, will help half of the nations uninsured get access to health care. If we don’t support Medicaid Expansion on a state level our nations poorest will go without healthcare. This will drive the cost up for the rest of us and create a great imbalance between states, tension and unrest. There is nothing that is more damaging to our democracy then dividing the states. If you believe in health care reform, support Obamacare’s Medicaid Expansion in your state.