At Wonkblog, Sarah Kliff has a revealing map of the states that have agreed to the Obamacare Medicaid expansion, are undecided, or have rejected it. Take a look:
Eighteen states will accept the Affordable Care Act's Medicaid expansion—or are leaning towards it—17 are undecided, 7 are leaning "no," and 9 will not expand it.
It's worth emphasizing how important this is: Of the 32 million people slated to receive health-care coverage under the ACA, just over 21 million will receive it by way of the Medicaid expansion. If states like Texas, Florida, Georgia, and Virginia decide to reject it, millions of people will go uninsured for no reason other than political pique.
My hunch is that conservative states will be able to avoid the Medicaid expansion in the short run, but that longer-term pressure will force them to yield. Remember, the federal government is offering to cover 90 percent of the cost of the expansion, meaning—in effect—that states are receiving a huge award of free money.
Conservative politicians might oppose the "hand-out," but interests with a vested stake in the money—hospitals, doctors, insurance companies—will want to see states take it. It's unfortunate, but that—and not the needs of state residents—will likely lead to more states adopting the Medicaid expansion.
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