States’ Medicaid decisions scrutinized

President Obama spoke Sunday at a Kennedy Center Honors reception at the White House that recognized Buddy Guy, Dustin Hoffman, David Letterman, Natalia Makarova, John Paul Jones, Jimmy Page, and Robert Plant for their lifetime contributions to American culture through the performing arts.


President Obama spoke Sunday at a Kennedy Center Honors reception at the White House that recognized Buddy Guy, Dustin Hoffman, David Letterman, Natalia Makarova, John Paul Jones, Jimmy Page, and Robert Plant for their lifetime contributions to American culture through the performing arts.

Hundreds of billions of dollars and the well-being of millions of people will be at stake when more states consider in coming months whether to expand Medicaid under the federal health care overhaul. As legislatures look ahead to their 2013 sessions, the calculating and the lobbying have already begun.

President Obama’s law expands Medicaid, the federal-state health program for low-income people, but cost-wary states must decide whether to take the deal.


If they turn it down, governors risk coming off as callous toward their neediest residents. And they will probably be second-guessed for walking away from a pot of federal dollars estimated at nearly $1 trillion nationally over a decade.

If the Obama administration were to compromise by sweetening the offer to woo a reluctant state, it would face immediate demands from 49 others for similar deals that could run up the tab by tens of billions of dollars.

Get Ground Game in your inbox:
Daily updates and analysis on national politics from James Pindell.
Thank you for signing up! Sign up for more newsletters here

Conservative opponents of the health care law want state lawmakers to turn down the Medicaid money. Hospitals, doctors’ groups, advocates for the poor, and some business associations are pressing them to accept it. So far, eight states have said they will turn down the expansion, while 13 states plus the District of Columbia have indicated they will accept it. The eight declining are Alabama, Georgia, Louisiana, Maine, Mississippi, Oklahoma, South Carolina, and Texas. Nearly 2.8 million people would remain uninsured in those states, according to Urban Institute estimates, with Texas alone accounting for close to half the total.

Medicaid covers nearly 60 million low-income and disabled people but differs significantly from state to state. Under the health care law, Medicaid would be expanded on Jan. 1, 2014, to cover people making up to 138 percent of the federal poverty line, or about $15,400 a year for an individual.

About half the 30 million people gaining coverage under the law would do so through Medicaid. Most of the new beneficiaries would be childless adults; about 2.7 million would be parents with children at home. The federal government would pay the full cost of the first three years of the expansion, gradually phasing down to a 90 percent share.


The Supreme Court ruled that states can turn down the Medicaid expansion. But if a state does so, many of its poorest residents would have no way to get health insurance.

The subsidized private coverage also available under Obama’s law is only for people making more than the poverty level, $11,170 for an individual. For the poor, Medicaid is the only option. Although the health care law fully funded the Medicaid expansion and Obama has protected the program from cuts, the federal government’s unresolved budget struggles do not give states much confidence.

A recent economic analysis by the nonpartisan Kaiser Family Foundation and the Urban Institute found that states will receive more than $9 from Washington for every $1 they spend to expand Medicaid, and a few will actually come out ahead, partly by spending less on charity care. States are commissioning their own studies.

Hospitals aren’t taking ‘‘no’’ for an answer in the states that have turned down the expansion.

Although South Carolina’s governor, Nikki Haley, a Republican, has had her say, the Legislature has yet to be heard from. In Maine, Democrats who gained control of the Legislature in the election are pushing to overcome opposition by Governor Paul LePage, a Republican.

‘‘Obamacare’’ was once assailed as a job killer by detractors, but on Wednesday the state’s hospital association estimated that the ripple effects of the Medicaid expansion would create 24,000 jobs in the state. It said about 160,000 state residents would gain coverage.

‘‘This is not a political issue for us . . . this is the real world,’’ said Joe Pierle, head of the Missouri Primary Care Association, a doctors’ group. ‘‘It makes no sense to send our hard-earned federal tax dollars to our neighbors in Illinois.’’

Bill Clinton joins Obama for a round of golf

Bill Clinton joined President Obama for a round of golf at Joint Base Andrews in Maryland on Sunday.

Also in the group, according to the White House, were US Trade Representative Ron Kirk and longtime Clinton backer and strategist Terry McAuliffe, who will run for governor in Virginia in 2013.

Clinton was a big help to Obama in the president’s reelection campaign; he was praised as an exceptional surrogate who made dozens of appearances for the incumbent and vouched for his economic record.

Loading comments...
Real journalists. Real journalism. Subscribe to The Boston Globe today.
We hope you've enjoyed your free articles.
Continue reading by subscribing to for just 99¢.
 Already a member? Log in Home
Subscriber Log In

We hope you've enjoyed your 5 free articles'

Stay informed with unlimited access to Boston’s trusted news source.

  • High-quality journalism from the region’s largest newsroom
  • Convenient access across all of your devices
  • Today’s Headlines daily newsletter
  • Subscriber-only access to exclusive offers, events, contests, eBooks, and more
  • Less than 25¢ a week
Marketing image of
Marketing image of