Consequences of the Supreme Court’s Medicaid expansion decision

In light of the Supreme Court’s ruling on the Affordable Care Act, several experts and news outlets are focusing on the effects of the courts decision to limit the scope of the ACA’s Medicaid expansion. Prior to the Supreme Court’s decision, the ACA allowed the government to withhold all of a State’s Medicaid funding if that state chose not to expand their own Medicaid programs to include adults without disabilities and children. The Supreme Court’s decision now allows states to opt out of the expansions. The Congressional Budget Office has estimated that giving states the choice to opt out of Medicaid expansion may add $50 billion to the annual cost of the ACA.

At the time of the ACA’s passage, the proposed Medicaid expansion was estimated to offer healthcare coverage to 17 million Americans, but since then, some reports have increased that estimate to 25 million. Since the federal government offered to cover 100% of the costs of the expansion through 2016, and then dropping to 90% by 2019, some have argued that Medicaid expansion makes good policy and fiscal sense for states. Others have said that for poorer states with stretched budgets, the expansion could stretch budgets after the federal contribution drops, and that depending on state Medicaid eligibility requirements, there is still a sector of poor Americans who will continue to go uncovered.

For state policy and politics reporters, this week’s decision creates an opportunity to report and explain how your state will begin handling Medicaid expansion with the new opportunity to opt out. Though Medicaid expansion is set to begin in 2014, state policy makers will have to start making decisions soon about whether to expand their own Medicaid programs and how to do so.

To turn this into a story:

  • First, search policy statements and press releases from Governors’ offices and State Health and Medicaid Departments to see if they have made overt commitments to expanding or not expanding Medicaid programs.
  • Be aware of your state’s existing Medicaid eligibility requirements. has information for every state.
  • Ask officials from health departments about how the practical aspects of expanding Medicaid. What will they need to handle more people? How will they identify people who now qualify? Do they foresee administrative headaches with the expansion?
  • Ask doctors and hospital administrators about serving patients with Medicaid. Will this improve the quality of their care? Will expanded Medicaid cut down on the cost of providing care to uninsured patients?
  • These helpful tutorials give further information for covering poverty in health and politics.

Other poverty reporting and commentary from across the web

Morning Sun (Piitsburgh, Ka.) — Poverty strike health, education across 4 state region

Huffington Post — Report: Culture and policy changes needed in high-poverty schools 

NBC Dateline — In suburbia, middle class begins to confront poverty

New Orleans Times-Picayune: Poverty numbers down in Southeast Louisiana

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