States opting out of Medicaid expansion could leave many uninsured

CBS/AP

Updated at 2:05 p.m. ET

(CBS News) Now that the Supreme Court has given the states more flexibility concerning what parts of the Affordable Care Act they must implement, more Republican governors are confirming they plan to "opt out" of a plan intended to give millions of poor Americans health coverage.

Florida Gov. Rick Scott on Sunday announced his state is opting out of an expansion of Medicaid, a joint federal-state health care program, now that the court will allow it to do so. Florida is also choosing not to build an "exchange," the state-based health insurance marketplace every state is expected to establish by 2014.

"Floridians are interested in jobs and economic growth, a quality education for their children, and keeping the cost of living low," Scott said in a statement. "Neither of these major provisions in ObamaCare will achieve those goals, and since Florida is legally allowed to opt out, that's the right decision for our citizens."

The office of South Carolina Gov. Nikki Haley told the Charleston Post and Courier that the Palmetto State is similarly opting out of both programs. And over the weekend, Govs. Scott Walker of Wisconsin and Bobby Jindal of Louisiana also said they're opting out.

Under the Affordable Care Act, states always had the choice to "opt out" of building an exchange. If they refuse to set up the health care marketplace, the Department of Health and Human Services will do it for them.

The Supreme Court-mandated option to "opt out" of the Medicaid expansion, however, could potentially leave millions Americans uninsured. Currently, Medicaid is a joint federal-state program that provides health care to certain poor Americans, such as children and the elderly. In 2014, President Obama's health care law would open up Medicaid to anyone with an income under 138 percent of the federal poverty line -- so long as their states have agreed to the new plan.

The expansion of Medicaid, according to the Congressional Budget Office, was expected to make available health care coverage to 16 million new people. That accounts for half of the 31 million expected to get coverage from the Affordable Care Act.

Supreme Court upholds health care mandate
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Originally, states were required to implement this expansion or risk losing all of the federal funding they receive for Medicaid -- an option no state could afford. The Supreme Court ruled last week that the federal government couldn't force this significant change to an already-existing program on the states.

Some health care experts said it was unthinkable that state leaders would really opt out, since the vast majority of the cost is covered by the federal government -- taxes their citizens will pay, regardless of whether the state opts in or out. For the first two years, the federal government pays for 100 percent of the expansion. Starting in 2017, the states start chipping in, but they will never contribute more than 10 percent of the cost.

"A governor would be walking away from millions, in some cases billions of federal dollars," Tim Jost, a consumer advocate and professor of health law at Washington and Lee University, told CBSNews.com.

Furthermore, they'd be leaving a significant portion of their citizens without health care. Florida, according to the nonpartisan Kaiser Family Foundation, has the second-highest rate of uninsured Americans at 21 percent. The expansion of Medicaid in the state would have covered 951,622 people according to Kaiser.

Jost said he's not surprised that governors like Scott and Haley are saying they will opt out of the Medicaid expansion. However, he said, "I will be surprised if they do it."

The Health and Human Services Department is making the same prediction. An official from the department pointed out to CBSNews.com that history suggests the states will get on board: All but two states implemented Medicaid and the Children's Health Insurance Program (CHIP) within five years of enactment -- despite their less generous financial support than this new Medicaid eligibility expansion.

"Ultimately, we don't believe States will turn down a good deal to cover more of their residents and pay their hospitals and doctors for their care," the official said.

If a state does choose to opt out, its citizens with incomes above 100 percent of the poverty line will be eligible for tax credits from the federal government to get insurance, but people below that threshold will remain the state's responsibility.

In his release, Scott said Florida can't afford the expansion, which he says would eventually cost the state $1.9 billion. Furthermore, he notes the state gives assistance for families with incomes up to 133 percent of the poverty line and that the Florida KidCare program insures children.

In South Carolina, the Medicaid expansion was expected to cover 344,109 people, according to Kaiser. South Carolina Medicaid Director Tony Keck told the Post and Courier that, since nothing really changes until 2014, "We have time to talk about it."

However, he said Haley's administration wants "more people covered, but we want it paid for under a model that works, not the status quo."

[ajain31]

Hello Friends,

Governor Rick Perry millions of under-privileged poor Texans who do not have any Health Coverage will be covered under The Affordable Care ACT (ACA) expansion of MEDICAID!

My Physician wife's practice is partly dependent on MEDICAID and its viability. Please allow the expansion of MEDICAID to occur in Texas under The Affordable Care ACT.

FACT: If states choose to expand Medicaid, the federal government will cover 100 percent of the costs from 2014 to 2016. The feds' contribution will begin to decrease in 2017, but will never be less than 90 percent, under the ACA.

That's why I created a petition to Governor Rick Perry, Texas Governor, The Texas State House, The Texas State Senate, and Governor Rick Perry, which says:

"Please ACCEPT the FREE EXPANSION of MEDICAID under The Affordable Care ACT."

Will you sign this petition? Click here:
http://signon.org/sign/accept-free-expansion?source=c.em.cp&r_by=7268737

Thanks!

Ajay Jain
[e-mail]
Twitter Handle ajain31
Mobile: [phone]

[11alana]

This is unconstitutional under equal protection laws. I am infuriated all of these governors are making such unilateral decisions about whether poor adults, many of whom are working poor, are going to receive the same health insurance that poor adults in 90% of the rest of the country are going to receive. I cannot fathom how this is not a violation of the equal protection laws. It makes me furious that these men are obstructing this particular program and keeping poor people from getting preventative care, this is what leads to people using the emergency room as their only doctor, a practice which means treatment is exhorbitant by the time the problem is found and supposedly contributes to high health insurance costs. I am fighting mad about these jerks thinking they have the license to do this to their citizens. Evil evil people.

[scgloe]

HOW DO FLORIDIANS FIGHT THIS? Is it LEGAL for Rick Scott, FL Governor, & the malicious FL leislauture to REFUSE Medicaid funding - to the detriment of Floridians (ill, impoverished, elderly) who need it in order to access health care? How can this be legal? How can a single State (Rick Scott & FL legislature) make a decision which diminishes & harms American Citizens (who reside in Florida)? How can Floridians ensure our Citizens aren't harmed by a single, malicious Governor (Rick Scott) & his warped, punitive ideology? If Scott continues to to 'ENFORCE' his 'decision', would Flordians need to (1)engage ACLU or (2)bring a Case to either State or Fed supreme Court? In other words, HOW DO FLORIDIANS FIGHT THIS?

[theloneconsumer]

So what the Governor of Florida is saying, he insures the children, but he will not insure the adults. Since Florida has many unemployed people (upwards of 20% that some have fallen off the unemployment criteria and Rick Scott has made it difficult to receive unemployment), what does Scott want people to do? Leave the state?
Because he was the man that was supposed to do 100,000 jobs in his term. So he refuses federal money, he refuses the Train speed rail money, even though the corporations insured there would not be any sdtate costs, when are we suppsed to get these jobs??
But in the same breath, he has no problems giving state "welfare" money to corporations that dissapear with incentive money for jobs they don't create, or people they fire after getting state money.

Do you see the hypocracy? And since he and Bondi don't provide for ALL of the state's citizens, he is making sure the down and out (and illegal aliens) don't vote. We are so lucky to have both of them.

[scgloe]

You are totally correct, and in answer to your question, Rick Scott likely wants Floridians who are not affluent, and do not work to leave the state or (worst case) end up in a Privatized FL Prison (Profits!). Rick Scott was CEO of a Privatized Hospital Chain, and was indicted for FED MEDICARE FRAUD. Scott didn't go to jail; one of his subordinates went to jail. So it's clear that Scott has no sense of conscious about throwing others 'under the bus'. He's a Corporate (?thug) and not concerned about other Human Beings. We're stuck with him until 2015. I don't know ANYONE who voted for R Scott.

[audemus]

When you get a bunch of rapidly aging white folks that don't really understand how health care works, afraid that somebody's going to get something for free....you have the perfect storm for a lot of the neediest among us not getting the medical attention they need.

If one sick, poor person dies in any of the states whose governors are saying they won't implement Medicaid expansion, because they were unable to access the care they needed, someone should be jailed. There are no more excuses to justify the insanity of the past....these whacked-out politicians from the right-wing will be flirting with at least doable manslaughter charges....maybe that would finally get their attention.

[71MACH1]

@ Audemus. That's right pick on the white folk. First everyone of us age at the same rate of one day at the time, regardless of race. Second of all, you are a racist ! Those old folks as you put it, are more understanding of health care and how it works. WE have had many more health care issues through the years than the youth of this country. Also if you are so lazy to go to work and pay into the system of S.S. etc., then you are one of those who just want something for nothing ! All the older people that are near or already getting S.S., have paid into S.S. from the beginning of their career. And most of all if you need medicaid expansion as soon as it has been announced, you are either one of the lazy people, unhealthy needy or speaking of a family member in bad shape. I guess you are looking for another hand out. There are much more to the expansion than meets the eye and has caused many of the states to make their choice as for now. THE EXPANSION STARTS IN 2014. It may cost the people more in the long run. You should quit your ******** and get on the road to improving your condition or situation. Just get a job for self satisfaction if you don't have one !

[scgloe]

You are correct. And it doesn't matter what Race is involved. American Citizens who genuinely need help with the BASICS - housing, food, health care - should not be demeaned, or denied assistance in a State/Nation with so much affluence.

If Rick Scott continues to 'enforce' his warped ideology, it will be contested & R Scott will lose. Just as R Scott was DEFEATED in his efforts to implement his idea that people seeking Welfare benefits had to pay for/pass a urinalysis/drug test in order to receive benefits (Scott's WIFE owned the Lab which would have performed the drug tests - so Scott's WIFE + Rick Scott - would have made ALOT OF MONEY $$$$$$$ off of Scott's idea!!) In my very humble opinion, I think many people have no respect for Rick Scott.

[ParadoxisOK]

What I find most odd about the teabag idiots, is that a large number of them are retired, drawing Social Security checks, using the Medicare program and living off of uncle. They call it socialism when others need the same assistance, but when you ask them to stand up for their false principles, like telling them to mail back their social security checks and to quit using the Medicare program, they always stupidly reply that they've earned it!!! Such blind, self serving fools they are! They are fascists socialist, the worst kind!

If you don't like "socialism", give back your Social Security check NOW! And start paying for your own medical care without your Medicare! See how long you can live in your lie! You're principles don't exist, teabaggers!

[ParadoxisOK]

LOL! I have encountered them in my business dealings over and over. I usually avoid politics with my East Texas customers, they are all over the top Republicans, but when they start cheering Beck and those other idiots of the teaparty, I usually just tell them to send give back their Social Security checks to the government and to stop taking their health issues to Medicare. They usually do come unglued, but they don't have an answer, they just rant or say they don't use either! Which is an obvious ball faced lie. Being self employed I do see all types of folks, most are honest hard working people, just trying to make a go of. But these teaparty idiots, they just don't have a clue!

[Teresa_in_Fort_Worth]

Excuse me, but you are woefully ignorant of the "promise" that was made to people by the government in regards to Social Security and Medicare.

We were "promised" that the Government would take a portion of our paycheck, put it in an "account", and then give us that money back when we retired.

Mind you, we don't have the OPTION of choosing to "allow" the government to hold our money for us - nope, we pay into this alleged retirement account our entire working lives. Same thing with Medicare - it is SUPPOSED to be a health insurance account for our old age.

We are not allowed to opt to put that money in a personal savings account for our retirement. When we retire, the government tells us how much of OUR money we are allowed to get back each month, and they hold us hostage to them.

When we die, any extra money that is leftover doesn't go to our family that is left behind - the government confiscates it all.

This entire country could be filled with millionaires whose "fortune" came to them as the result of their parents and grandparents saving for their retirement and their family's future.

So don't you DARE tell people that they are "supporting" socialism - every last person on Social Security PAID INTO THAT SYSTEM. There is nothing "socialist" about that.

The government made a promise to her people; the people acted in good faith.

And the government is dishonorable enough to hold its eldest and most vulnerable hostage whenever the mood suits them.

They aren't "living off of Uncle" - "Uncle" has been living off of their backs for their entire working life.

Spare me your hateful diatribes, and take the time to LEARN about things first.

[occupy_cbs]

In the wake of the Court ruling, more than half of Americans (56 percent) say they would like to see the law's detractors stop trying to block its implementation and instead move on to other national problems, while 38 percent say opponents should continue trying to halt the ACA.

Democrats, not surprisingly, are overwhelmingly likely to support the idea of moving on (82 percent), but they are joined by 51 percent of independents and 26 percent of Republicans.

http://www.kff.org/kaiserpolls/upload/8329-F.PDF

-----

Sorry republicans, but even mcconnell sees that it's an uphill battle for repeal without any replacement, and with the majority of Americans against the GOP need for repeal, it's done and we will move forward!

States with republican governors trying to deny health care for the poor through Medicaid, only prove they hate Americans!

[realist2010]

Joker, this spin is from you. What are you going to do when Romney loses in November? Start thinking about it and I'm hoping you carry yourself in a dignified way.

[scgloe]

RE: "States with republican governors trying to deny health care for the poor through Medicaid, only prove they hate Americans"

Occupy, I think you meant the GOVERNORS of such states seem to hate Americans, particularly Americans who are poor or in need.

I'd agree with you, if that is what you meant?

IF you meant "ALL PEOPLE who reside in states that have despotic Republican Governors hate Americans" - you're very misinformed/misguided (+ I'm being polite.)

[ParadoxisOK]

Romney is a corporate fascist as well as a flip floppin' idiot as are most fascists!

[scgloe]

Thank you, Paradox; you are completely correct. Romney made all his money off the backs of American workers who lost jobs - courtesy of M Romn. Romney is a corporate fascist, just like FL Gov Rick Scott.

It is ABSURD/INSANE to think a person like Romney would try to help working class people regain economic stability. I live in Florida, and I see first-hand (courtesy of R Scott)the VERY bad outcome our Nation would endure if Romney were elected. The USA, as we have known it, would be totally demolished - brought to our knees.

I think the ONLY reason people consider Romney is desperation. These are such terrible economic times & people are grasping at straws. It is stupid, but people are frightened & struggling. I don't know why Obama has been unable to turn things around, but regrettably many Americans continue to lose jobs, incomes are eroded, while prices escalate.

Obama has to be reelected because the alternative Romney is completely unacceptable. I hope things get better; it is a big mess right now.

Maybe the only way out of this is for us - the American Citizens - to help each other? I sense we're stuck in this mess 'on our own'? Politicians, Government, Corporations have failed us (just my VERY HUMBLE humble opinion!). But someone much smarter than me, Author John Steinbeck, wrote about this along time ago: The Grapes of Wrath.

Good luck to you!

[marychgo]

The chest-thumping from GOP governors is hardly a surprise. We'll see, however, if they're quite so anxious to refuse to sign on for expanded Medicaid under ACA once they've heard from their states' hospitals and physician groups and from people who would be eligible for expanded Medicaid. I'm not saying it's a simple decision; there are genuine funding issues for states. But I don't think even Texas' Rick Perry is BRAGGING about the fact that his state has more uninsured citizens than any other state!

[dbsdey]

So our Governor is chest-thumping. Evidently you don't realize that the working citizens of every state will have their taxes raised to cover the added Medicaid patients. If a state is forced to furnish insurance for everyone, who do you think is going to pay for it? The Federal Government will help pay for the added patients for two years, but after that the citizens of each state will be forced to pay for the additional Medicaid patients. If you are so rich that you can afford the extra taxes, that is great. As for the rest of us working folks, we can't afford to pay for our healthcare and everyone elses also. Please read the Healthcare Bill before you start making accusations against anyone. What if you had to pay for the auto insurance for everyone who could not afford it? It is exactly the same thing with Obamacare. We are being forced to pay for the health insurance for anyone who can't afford it, including illegals. Rant against the GOP all you want, but you are going to be taxed just like everyone else.

[YouAreTheJoke]

States will only have to pay up to %10. When you think about all the federal money that will be flowing into state hospitals, doctors, and nurses, the income and sales tax revenue from these people will more than offset this small amount.

[test43]

for a good talker how did Obama end up for such an unattractive wife?

[thosmith59024]

Unattractive in what way? She appears to be beautiful to me and probably to the president. Beauty my friend is in the eye of the beholder. Maybe your just not a beholder.

[thosmith59024]

Unattractive in what way? She appears to be beautiful to me and probably to the president. Beauty my friend is in the eye of the beholder. Maybe your just not a beholder.