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ICYMI: Republican Governors Continue to Deny Americans Access to Health Care

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Even after one of the worst economic and public health crises in our nation’s history, Republican governors are still hell-bent on denying vulnerable Americans access to health care. 


Right now, an estimated 2.2 million Americans still do not have access to affordable health care because 12 states have refused to expand Medicaid. In three of these states, Kansas, Wisconsin, and North Carolina, Republican-controlled legislatures have blocked Democratic governors’ efforts. In the remaining nine states, Republican governors are to blame and they’re not looking to change course any time soon. 


Medicaid expansion is overwhelmingly popular, even among Americans in red states. Ten Republican governors have expanded the program, including former Vice President Mike Pence as governor of Indiana. Voters in Oklahoma, Nebraska, Utah, Idaho, and Missouri voted in favor of Medicaid expansion via ballot initiative as recently as last year. And Democratic governors have won big in red states on advancing access to quality, affordable health care – Louisiana Gov. John Bel Edwards won his reelection by campaigning on Medicaid expansion in 2019.


Even as Congressional Democrats try to offer states a higher federal funding match as a greater incentive, Republican governors are still putting partisan ideology ahead of life-saving policies. Florida Gov. Ron DeSantis “remains opposed to the expansion of Medicaid,” while South Dakota Gov. Kristi Noem “knows that expanding Medicaid is not the answer.”


No matter how it’s phrased, the sentiment is the same: Republican governors don’t want vulnerable Americans to have health care. 


Read more about how Republican governors continue to be a blockade against a healthy country:


Vox: A New Democratic Plan to Expand Medicaid Hits a Big Snag: Republican Governors


As part of their Covid-19 stimulus bill, Democrats are trying to cut a deal with Republican-led states to plug one of the biggest holes in Obamacare: the so-called Medicaid expansion gap.


But conservative state officials don’t sound interested in taking it. Based on an informal survey of the states yet to expand Medicaid, the provision in the stimulus bill that provides increased funding for states that expand the program now may end up having no effect at all. That would mean millions of people in poverty remaining uninsured.


Medicaid expansion is the unfinished work of the Affordable Care Act. The 2010 law was written with the intention that every state would expand the program to people living in or near poverty. But then the Supreme Court ruled that the federal government couldn’t force states to expand Medicaid; they must have a choice. As a result, 12 states have for the last decade refused Medicaid expansion, and an estimated 2.2 million Americans who would have been otherwise covered by the expansion are still uninsured and have no other realistic option for affording coverage. Most of them live in the South and they are disproportionately Black.


Democrats now are offering a new enticement for the holdout states to expand Medicaid. Already, under the ACA, the federal government would cover 90 percent of the expansion’s costs. Under the stimulus bill, newly expanding states would also receive a 5 percent bump in the federal funding match for their traditional Medicaid programs for two years. Because the traditional Medicaid population is significantly larger than the expansion population, the funding bump is projected to cover a state’s 10 percent match for expansion enrollees and then some over those two years.


Texas and Florida, the two largest holdout states, could net $5.9 billion and $3.5 billion respectively if they took the deal, according to estimates from the Center for Budget and Policy Priorities. Even a smaller state like Mississippi is looking at $890 million in additional federal funding — while covering an estimated 100,000 people currently without any other option for health insurance.


But based on my reporting, the holdout states appear unmoved and are unlikely to take the deal.


Republican states say they aren’t interested in Democrats’ new Medicaid expansion deal


I hopped on a press conference this week with Mississippi Gov. Tate Reeves (R) to ask him whether the new funding incentive would prompt him to reevaluate the decision to refuse Medicaid expansion.


“No, sir, it will not,” was his answer.


I heard the same from other governors’ offices in the non-expansion states.


“The Governor remains opposed to the expansion of Medicaid in Florida,” Cody McCloud, spokesperson for Florida Gov. Ron DeSantis (R), said in an email.


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“Governor [Kristi] Noem knows that expanding Medicaid is not the answer to accessing quality healthcare in South Dakota,” Ian Fury, a spokesperson for the South Dakota Republican governor, said in an email.


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The fact is that the Republican opposition to Medicaid expansion is more ideological than practical. These states have objected to the expansion despite evidence that it is cost-effective and saves lives.


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“Medicaid expansion appears to be a win-win from the states’ perspective,” the authors, Jonathan Gruber and Ben Sommers, wrote, “giving health insurance to millions of low-income adults and offering financial support to safety-net hospitals, without any adverse effects on state budgets.”


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Moreover, Medicaid expansion is popular, even with red-state voters. Voters in Utah, Idaho, Oklahoma, Missouri, and Nebraska have approved Medicaid expansion via ballot initiative. A recent survey by Data for Progress found voters in non-expansion states expressed solid margins of support for extending the program’s eligibility under the ACA.


And yet, conservative state leaders haven’t budged. Their intransigence has created a bizarre disparity for the Democrats’ Covid-19 stimulus legislation, which will likely succeed in extending more generous premium tax subsidies to middle-class Americans but appears destined to fail in covering uninsured people in poverty.


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