The seven-year war over Obamacare, which seems to be winding down after the collapse last week of the GOP’s half-baked replacement plan, inflicted real damage on one vulnerable group: low-income people in states that refused, for political reasons, to accept the law’s Medicaid expansion. An estimated 2.6 million Americans in those 19 states lack coverage as a result. If anything good comes from the GOP’s health care debacle, it should be a signal to those states that they’re no longer proving anything by refusing to take federal money.
The expansion of Medicaid was a key feature of the Affordable Care Act, and one of the reasons the law has driven the uninsured rates so low in states that accepted the cash. Obamacare opened up Medicaid to individuals with incomes up to 138 percent of the poverty level and allowed people without children to qualify. When the law was written, Congress required all states to take the expansion, but the Supreme Court ruled in 2012 that states could decline if they wished.
And that seemed to be reason enough for Republican-led states, including Georgia, North Carolina, Florida, and Texas. Provided with an opportunity to take a stand against Obamacare, Republican governors and legislatures seized it. In Texas, according to the Kaiser Family Foundation, 684,000 adults went without coverage because of the decision to reject the money. No insurance, for many people, means no health care.
The logic to rejecting the expansion was mostly political, not budgetary, since the federal government pays for 100 percent of the expansion initially and 90 percent thereafter. One opponent of expansion, former Texas governor Rick Perry, explained that he was acting to keep so many Texans uninsured in order to fight against ‘‘brazen intrusions into the sovereignty of our state.’’ Only a few Republican governors, like Ohio’s John Kasich, were able to place compassion and common sense before partisanship and take the money.
Now, after the failure of the repeal-and-replace plan, one of the nonexpansion states, Kansas, is moving to join the expansion. Georgia’s Republican governor, Nathan Deal, is also said to be reconsidering the state’s opposition to expanding Medicaid. Better late than never.
In New England, only Maine has failed to accept the money, even as the state grapples with a raging public health crisis from opioid addiction. The state’s GOP governor, Paul LePage, has vetoed expansion six times, and fed-up Mainers gathered enough signatures to put the issue to a referendum later this year. Expansion would provide an estimated 70,000 people with coverage; the state’s legislature could head off the referendum by approving expansion with a veto-proof majority.
After all, taxpayers in Maine — and the other states that spurned expansion — have funded Medicaid expansion in the 31 states that accepted it. Republican leaders in those states might have imagined that, in rejecting the expansion, they were making it easier to repeal Obamacare, by preventing one part of it from taking root. If so, the crumbling of the GOP health bill last week should make it clear that the joke is on those states — and their residents.
