About half the states have not expanded Medicaid, which means they didn’t make it available to all low-income people as the Affordable Care Act’s architects originally intended. And the human cost of these decisions has been obvious for some while. People who desperately need insurance aren’t getting it. They’re more likely to experience financial hardship and, if the latest research is correct, they’re more likely to die.
Conservative state officials and their supporters frequently justify the decisions by arguing that they are simply looking after their states’ finances. Even with the federal government picking up most of the cost, they say, states must put up some money of their own—and the states don’t have the money to spare.
A new report from researchers at the Urban Institute, and supported by the Robert Wood Johnson Foundation, shows just how shortsighted that decision is. Yes, states have to spend money to expand Medicaid. But they get much, more back from the federal government. That money ends up flowing to medical professionals, hospitals, and other parts of the health care sector.
The Urban Institute researchers have made projections for just how much money each state is implicitly giving up by refusing to expand Medicaid. Georgia is a good example. According to the Urban report, Georgia would have to spend an additional $2.5 billion over the course of a decade in order to finance its share of the Medicaid expansion. But the state is giving up more than ten times that—$33.5 billion—in federal funds.
What’s it like for other states? You can check out the interactive map above. Note that these projections are consistent with a previous report that some of the same researchers did for the Kaiser Family Foundation.
Conservatives who oppose the Medicaid expansion make other arguments, of course. They say they don’t want to increase federal spending, they think Medicaid is a lousy insurance program, and, more generally, they don’t like big government. Those are fine arguments to have. But the idea that expanding Medicaid is a poor financial decision for states is not just wrong. It appears to be the opposite of the truth.
Update: I revised the chart and then added the one below, so you can see the federal dollars lost in per capita terms, as well.