No, Medicaid expansion hasn’t been a complete success, and contrast to the HealthCare.gov troubles, the issue isn’t technical: it’s political. Due to the Supreme Court’s 2012 ruling that states can opt out of the Affordable Care Act’s expansion of Medicaid, only half of the states — all of them Republican-controlled — have elected to extend Medicaid coverage according to the Affordable Care Act’s provisions. As a result, millions of low-income Americans are missing out on health insurance because they don't meet their state's income qualifications for Medicaid. Some of the qualifications are ridiculously low: a single mother of three kids in Texas must make under $3,737 to receive Medicaid.
Chris Walker, a data visualization expert, created an interactive graphic (scroll down to see) showing the impact of a state’s decision whether to extend Medicaid coverage. Using a report from the Kaiser Family Foundation, Walker’s visualization is a perspective on the contrast between what level of income qualifies for Medicaid coverage in states that adopted the ACA's provisions and those that opted out.
The Affordable Care Act married two approaches to expanding health care coverage to the estimated 48 million uninsured Americans: the much talked about health insurance marketplaces including HealthCare.gov, and expanding Medicaid to low-income individuals. The online marketplaces are still a bit of a mess, but Medicaid enrollment has been going steady since day one.
Last week, a market analysis firm reported that 440,000 people in 10 states have signed up for Medicaid in the six weeks since enrollment began "Medicaid is exceeding expectations in most places," said Dan Mendelson, Avalere's president. "It is definitely a bright picture in states that have chosen to expand."
That’s the thing: tough luck if you live in a state that has elected not to expand the Affordable Care Act’s Medicaid provisions.
The Medicaid expansion is financed by the federal government for the first three years, but decreases after that to 90 percent. The state's assumption of financial responsibility is among the reasons some states have balked at the Medicaid expansion. Sen. Orrin Hatch (R-Utah) argued, "Cash-strapped states are also feeling the burden of the Medicaid entitlement. The program consumes nearly 22 percent of states’ budgets today, and things are about to get a whole lot worse.”