October 21 2013
Expanding Medicaid under the Affordable Care Act (ACA) is both contentious and complicated. RAND mathematician Carter Price has been using the COMPARE model to help those making decisions understand what their choices mean for their budgets and population health.
What exactly does “Medicaid expansion” mean?
The ACA provides three basic ways to increase the number of people who have health insurance: Medicaid expansion, the newly created insurance exchanges for individuals, and insurance exchanges for small businesses. Expansion of Medicaid raises the income ceiling to include people who currently aren't eligible for Medicaid, but who don't have the resources to purchase insurance on their own. All states have some kind of Medicaid program coverage although requirements differ. Some states worry that expanding the program will break their bank.
Aren't states required to expand Medicaid?
No. In June 2012 the U.S. Supreme Court ruled that states could opt out of expansion. As of spring 2013, 14 states announced that they wouldn't expand the program. Expansion is a moving target because state decisions are unfolding right now. But these 14 states were the first to announce that they were opting out. We've been studying the implications of opting out, and for our initial work we used these 14 states in our analysis. Current estimates put the number of states likely to opt out at 26. For subsequent analyses, we have used the most recent tally of states.