WASHINGTON – If the 23 states that have rejected expanding Medicaid under the 2010 health care law continue to do so for the next eight years, they'll pay $152 billion to extend the program in other states — while receiving nothing in return.
This exodus of federal tax dollars from 2013 through 2022 would pay 37 percent of the cost to expand Medicaid in the 27 remaining states and Washington, D.C., over that time.
Nearly $88 billion would come from taxpayers in five non-expansion states: Texas, Florida, North Carolina, Georgia and Virginia.
The findings are part of an analysis of data from the Urban Institute, a nonpartisan research center that's advised states on implementing the Affordable Care Act.
Non-expansion states would see direct benefits from their $152 billion only if they reversed course and expanded eligibility for Medicaid, the state and federal health program for low-income Americans. The health care law provides financial incentives for states to extend Medicaid coverage to adults who earn up to 138 percent of the federal poverty level.
If the non-expansion states did so, they would still have to pay the $152 billion. But the 23 states also would split nearly $386 billion in federal Medicaid funding from 2013 to 2022.
The money would cover all medical costs for newly eligible Medicaid enrollees from 2014 through 2016, and no less than 90 percent thereafter.
"Here is money that is pretty much there for the asking, and these states are turning it down. And in the meantime, their taxpayers are paying taxes that fund expansions in states that are moving forward. It just doesn't make any sense," said Sherry Glied, the dean of the Robert F. Wagner Graduate School of Public Service at New York University.
The federal funding under Medicaid expansion also would stimulate economic activity, boost tax revenue and create hundreds of thousands of jobs in the states without Medicaid expansion.
