When the Supreme Court ruled on the Affordable Care Act last
year, it was widely hailed as a win for the healthcare reform law. While the Court upheld the law’s core provision
establishing health insurance exchanges, it found that the federal government
could not force states to expand their existing Medicaid programs. The expansion was one of the several means
established by the law to ensure that every American will be covered by health insurance.
As the Medicaid program stands now, children, pregnant women, the disabled, and
the elderly can receive assistance through Medicaid if they are at, or below
133 percent of the federal poverty line. That qualification breaks down to
about $31,000 for a family of four and $15,000 for an individual. The Court struck down the provision that
would have forced states to extend the program to any adult or family that is
below 133 percent of the poverty line, regardless of their age or physical
condition. That decision is left to each individual state.
According to statistics from this Stateline article,
21 states have accepted the expansion so far. That number could increase as
well, as the Democratic governors of Arkansas, Missouri, and Montana have all
expressed a willingness to expand the program, despite challenges from their
state legislatures. Since there is no
deadline associated with this decision, some predict that it could be years
before states decide if they will extend their Medicaid programs.
The federal government has pledged to pay all of the costs
for the first three years of the program for any state that joins in expanded
coverage, and up to 90% of costs after that. Many states, however, worry that the
federal government will not be able to make good on its promise. There is also
a concern that funding even 10% of the expanded program at the state level
could be more than a state would be able to cover.
The decision to expand coverage is something that will
likely be discussed in many state legislatures this year. Each state will have to
weigh its own costs and benefits in the long run, and deal with conflicting ideas
of the role of government in health care.
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