As expected, more states accepting Medicaid expansion in 2013

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State opposition to the use of federal funds for Medicaid expansion as part of the Patient Protection and Affordable Care Act is starting to crumble, experts tell Consumers Digest.

Four states that had opposed the expansion of Medicaid eligibility indicated in February and March 2013 that they will reverse course, and other states that had opposed it might follow in the months ahead, according to two experts whom we interviewed.

The change of heart by some states represents the start of a domino effect that experts had predicted during the past 8 months in stories. Experts believe that it could be just a matter of time before other states agree to approve the expansion of Medicaid eligibility within the state.

Without Medicaid expansion, the burden of paying for health-care services for uninsured low-income individuals in each state falls primarily to cash-strapped local governments. As a result, elected officials who represent opposition states are facing pressure from county and municipal officials to accept federal tax dollars so more individuals can have access to Medicaid, says Elena Marks, who is a health-policy expert at Rice University’s James A. Baker III Institute for Public Policy.

Among other initiatives, the Affordable Care Act seeks to expand Medicaid eligibility in each state for an additional 12 million individuals, and the federal government would pay states to cover the majority of those costs.

Since Feb. 4, 2013, the governors of Arkansas, Florida, New Jersey and Ohio have announced that they will allow the federal government to pay for Medicaid expansion in those states. The four states were among the 26 that initially said they would reject federal funds for Medicaid, because their governors don’t want to increase the federal budget.

Opposition still exists, of course. Republican state legislators in Florida say they will try to block Republican Gov. Rick Scott’s support of Medicaid expansion. In Nebraska, Republican Gov. Dave Heineman announced Feb. 27, 2013, that his state will continue to oppose federally funded Medicaid expansion. Two other states that initially opposed Medicaid expansion—Tennessee and Utah—are reviewing the issue and likely will make a final decision later in March 2013.

As of March 5, 2013, 27 states signaled that they support the use of federal dollars to expand Medicaid, according to Henry J. Kaiser Family Foundation, which is a health-policy-analysis organization that compiles a database of Medicaid expansion in each state. Seventeen states are listed as opposing expansion, while seven states are listed as undecided on the issue. To determine the status of your state, click here.

Even states that most strongly oppose Medicaid expansion are likely to accept it as more states sign on, says Genevieve Kenney of social-policy research group Urban Institute. Kenney says residents in opposition states likely will pressure their state leaders to accept federal funds when they realize that their federal tax dollars pay for Medicaid expansion in other states.

Marks believes that even Texas, where state elected officials staunchly oppose all provisions of the Affordable Care Act, eventually could accept Medicaid expansion for the same reason, which is to say that Texas won’t want other states to benefit from their tax money.

“I am cautiously optimistic that Texas will seize on this opportunity because of the health benefits to the people who would gain coverage,” Marks says.