Lives and Livelihoods Lost: The High Cost of Rejecting Medicaid Expansion

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2014 Projected Death CountThe Affordable Care Act (ACA) gives 16 million uninsured Americans access to non-emergency health care for the first time by offering more than $800 billion in federal funding to states over the next 10 years to expand Medicaid. So far, 25 states and the District of Columbia have opted to take advantage of this money to provide health coverage to adults with incomes of up to 138 percent of the Federal Poverty Level. This Medicaid expansion will improve individuals’ health, extend thousands of lives, increase economic growth and strengthen the financial stability of hospitals on which both rich and poor rely.

In the rest of the states, political leaders who are openly hostile to the law are prioritizing their anti-ACA agenda and callously denying health benefits to millions of adults who would otherwise be eligible for Medicaid. The states that so far have opted out of Medicaid expansion are rejecting a breathtaking $426 billion in federal funds over 10 years. These infusions of federal funds would spark regional economies by increasing employment, boosting household spending and generating significant tax revenue to support state and local services.

Live and Livelihoods Table 1

Source: Kaiser Family Foundation available at

When uninsured people gain Medicaid coverage, they become healthier and life expectancy increases. But in states that refuse to expand Medicaid, nearly 5 million people will find themselves in limbo — unable to afford unsubsidized private insurance and also ineligible for both the public safety-net program and subsidies to purchase plans in the ACA marketplaces. Significantly, research show save the lives of more than 27,000 people in 2014. Governors and legislators who refuse to fully participate in Medicaid must face up to the moral and ethical implications of blocking health coverage for their most vulnerable constituents. This policy choice is not only unconscionable, it harms everyone in those states, whether insured or not.

Governors and state legislators who fight the health care law by failing to use available federal funds to expand Medicaid enrollment also compromise the economic competitiveness and fiscal outlook of their states, according to data developed by health care advocates, hospital associations, think tanks, universities and researchers. Hospitals in non-expansion states will be put at a severe competitive disadvantage that will result in insurers excluding them from their networks, which in turn will force hospital administrators to offset lost business with increased out-of-pocket costs for people with private insurance. Rejection may satisfy the ideological fervor of officeholders averse to the ACA, but it does not relieve health care providers of the legal obligation to provide emergency care and stabilization to the uninsured under the Emergency Medical Treatment and Labor Act, which was signed into law by President Ronald Reagan in 1986. State and local governments, private insurers, hospitals and doctors must shoulder the costs of caring for the uninsured. While expansion states enjoy new federal investment and economic growth, residents of non-expansion states will face a declining quality of life, a weaker economy, and destabilized hospitals—including some that will be forced to close their doors.

Download the full report: Lives and Livelihoods Lost: The High Cost of Rejecting Medicaid Expansion