Should states expand their Medicaid programs to cover more of the uninsured under the Affordable Care Act? Lean Forward's Evan Puschak found out what one doctor serving a struggling New Jersey community thinks.
A U.S. Court of Appeals ruled that Texas does have a right to block federally provided funds from going to Planned Parenthood clinics within the state.
Earlier this year, the state sought to block funds from its TexasWomen's Health Program, the bulk of which came from the federal government, from going to any health organization affiliated with abortion providers. In addition to other health services, some Planned Parenthood clinics provide abortions.
A federal judge had previously issued an injunction that temporarily halted the ban from going forward. With this new ruling, Texas officials have said that the state will now put a stop to those funds for Planned Parenthood.
Planned Parenthood, which has sued to overturn the rule, said its clinics could lose up to $13 million a year and impact some 52,000 Texas women. The federal government promised in March to withdraw its funds from the Texas program that is supposed to aid low-income women if the rule goes forward.
Texas is the most populous of a number of states with Republican majorities that have mounted a campaign to cut off funding to Planned Parenthood. A group of Planned Parenthood clinics earlier this year filed a federal lawsuit to stop Texas from cutting off the funding.
After the appeals court decision was announced, Texas said it would immediately stop providing money to Planned Parenthood under the Women's Health Program, which provides services to poor women.
Republican candidate for president Mitt Romney has vowed to put an end to any federal funds going to Planned Parenthood if he is elected president.
Mitt Romney introduces Rep. Paul Ryan as his runningmate.
In picking Rep. Paul Ryan, Mitt Romney has taken a risk. The Wisconsin lawmaker has emerged in recent years as the ideological standard-bearer for his party, and in particular for its radical push to shrink the size of government. "To envisage what Republicans would do if they win in November, the person to understand is not necessarily Romney, who has been a policy cipher all his public life," Ryan Lizza wrote in The New Yorker last week. "The person to understand is Paul Ryan."
Here are 5 things you should know about Romney's new running mate:
• The Ryan budget, "The Path to Prosperity," would end Medicare as we know it by turning it into a voucher program, slash food stamps for struggling Americans, and turn Medicaid over to the states. Virtually the entire GOP, including Romney, have signed onto the plan as a centerpiece of the party's legislative agenda.
• Ryan's plan also would further tilt the tax system toward the rich. He'd extend the Bush tax cuts for the richest 2 percent, but not President Obama’s cuts for those who earn the least. Here's a chart, compiled by the Center on Budget and Policy Priorities, which shows the skewed distribution:
• Ryan also supports privatizing Social Security and turning it over to Wall Street. Had the plan been in effect during the 2008 financial crisis, millions of seniors' benefits would likely have been decimated.
• The economy suffers from a lack of demand, and by slashing spending, Ryan's plan would worsen the problem. It would result in over 4 million lost jobs over the next 2 years, according to a study by the Economic Policy Institute.
• Though he has tried to deny her influence recently, Ryan has claimed to be a devotee of the radical libertarian writer Ayn Rand. “The reason I got involved in public service, by and large, if I had to credit one thinker, one person, it would be Ayn Rand,” he once said at a Washington event in Rand's honor. “I give out ‘Atlas Shrugged’ as Christmas presents, and I make all my interns read it. Well… I try to make my interns read it.” Rand's philosophy centers on the notion that selfishness in the pursuit of profit is a virtue and that altruism is "evil," as she put it.
Looking for one piece of writing that captures what Ryan's all about? Read this masterful profile by New York magazine's Jonathan Chait, "The Legendary Paul Ryan."
Many states are currently mulling whether to expand their Medicaid programs under the Affordable Care Act (ACA). (Our interactive map shows just how likely each state is to participate in the program.) Now, a new survey finds that 2 out of 3 Americans support that aspect of the law—at least in theory.
Sixty-seven percent of respondents to a poll released Tuesday by the Kaiser Family Foundation (pdf) said they're favorable toward the provision in the law to "expand the existing Medicaid program to cover more low‐income, uninsured adults." 30% opposed it. Among political independents, the level of support was identical to the overall figure: 67%.
But when participants were asked whether they support their own state expanding Medicaid, the number in favor declined to 49%.
The Supreme Court ruled last month that states could decide for themselves whether to participate in the ACA's expansion of Medicaid. Several states have said flatly that they'll opt out, potentially leaving millions of low-income Americans without insurance.
Earlier Tuesday, we posted a map that assesses the likelihood of each state participating in the Affordable Care Act's Medicaid expansion—something the Supreme Court ruled states had the right to do.
Now, the non-partisan Congressional Budget Office has produced its own estimate (pdf) of how many Americans are likely to lose coverage because their state opts out of the expansion: 3 million.
The CBO report doesn't lay out which states it expects will participate and which won't (we think our map remains the best guide to that question). But it does predict that "some states will probably forgo the expansion entirely," meaning about 6 million people will be prevented from joining Medicaid. However, it projects, around 3 million of those will qualify for subsidies to be covered under the state exchanges—leaving another 3 million without coverage.
The report's main focus is the cost of the law. CBO calculates that with 3 million fewer people covered, that cost will fall by about $84 billion.
Leaning NO
744.1K (16% of state)
244.8K
$10.3B
Jennifer Ardis, a spokeswoman for Gov. Robert Bentley (R): "We don't know if the state can afford it. We need to study the full implications of the ruling." Bentley called the ACA "the single worst piece of legislation to come out of Congress."
Leaning NO
121.8K (18% of state)
33.1K
$2B
Gov. Sean Parnell (R): "We will do everything we can in Alaska to limit the impact of Congress' decision to pass this tax increase to Alaskans."
Leaning NO
1.26M (19% of state)
81.1K
$2B
Gov. Jan Brewer (R) has not said whether she'll support expanding Medicaid, but called the ACA a "fiscal and regulatory nightmare." House Speaker Andy Tobin (R) is opposed: "I don't see us going along with the expansion if it's not mandated."
Leaning YES
540.3K (19% of state)
154.8K
$9.4B
Gov. Mike Beebe (D): "It'd take a pretty dang strong argument for me to say no to those people." Democrats control the state legislature.
YES
7.16M (19% of state)
1.4M
$44.7B
Gov. Jerry Brown (D): The Supreme Court ruling "removes the last roadblock to fulfilling President Obama's historic plan to bring health care to millions of uninsured citizens." Democrats control the state legislature.
UNDECIDED
688.7K (14% of state)
166.5K
$5.9B
Lorez Meinhold, health-policy director for Gov. John Hickenlooper (D): "It's premature to answer that question." Democrats control the state Senate, Republicans the House.
YES
385.6K (11% of state)
75.9K
$4.7B
In June 2010, the state became the first to approve the expansion.
YES
74.7K (12% of state)
15.3K
$902M
The District has already begun to implement the expansion.
UNDECIDED
107.1K (12% of state)
7.9K
$387M
The state has asked the Obama administration for more information about the cost of the expansion. Gov. Jack Markell (D): "Before we decide whether to choose that option, it seems prudent to get greater clarity and certainty from the federal government." Democrats control the state legislature.
NO
3.9M (21% of state)
683.5K
$20.1B
Office of Gov. Rick Scott (R): "Florida will opt out of spending approximately $1.9 billion more taxpayer dollars required to implement a massive entitlement expansion of the Medicaid program."
Leaning NO
1.9M (20% of state)
479.1K
$14.6B
Gov. Nathan Deal (R) said the state would be in a "holding pattern" until the election, but a spokesperson said the expansion would cost "money we don't have." Republicans control the state legislature.
YES
94.5K (8% of state)
42.4K
$3B
The state has already begun implementing the expansion. Gov. Neil Abercrombie (D): "The Affordable Care Act is our ally in Hawaii to provide health care for everyone."
Leaning NO
262.4K (17% of state)
59.1K
$2.4B
Gov. Butch Otter (R) has yet to take a definitive stance on the expansion, but called the ACA "bad for America from the beginning." Republicans control the state legislature.
YES
1.9M (15% of state)
429.3K
$19.3B
Gov. Pat Quinn (D): "The state of Illinois is going forward with the president ... to expand using Medicaid." Democrats control the state legislature.
Leaning NO
864.4K (14% of state)
215.8K
$8.5B
Gov. Mitch Daniels (R), who steps down in January, hasn't said definitively whether he supports the expansion, but called the ACA "wildly misguided." State Senate leader David Long (R) said the state can avoid a tax increase by "opting out of Obamacare's Medicaid mandate, which we will certainly do."
Leaning NO
345K (12% of state)
74.5K
$2.8B
Gov. Terry Branstad (R): It's "doubtful" Iowa will expand Medicaid. Democrats control the state Senate, Republicans the House.
Leaning NO
351K (13% of state)
89.3K
$3.5B
Sherriene Jones-Sontag, a spokesperson for Gov. Sam Brownback (R): "He will wait until after the November elections before making any decisions related to ObamaCare." Brownback has said that "[s]topping ObamaCare is now in the hands of the American people. It begins with electing a new president this fall." Republicans control the state legislature.
UNDECIDED
659.9K (15% of state)
250.7K
$11.9B
Gov. Steve Beshear (D): "We continue to review the Supreme Court's opinion, particularly on the Medicaid portion of the Affordable Care Act to determine what our options may be." Republicans, who control the state Senate, have called the eventual cost of the expansion "unsustainable." Democrats control the House and back the expansion.
NO
765.8K (17% of state)
277.7K
$7.3B
Gov. Bobby Jindal (R): "I don't think it makes sense ... I think it makes more sense to do everything we can to elect Mitt Romney to repeal Obamacare." Republicans control the state legislature.
Leaning NO
125.6K (10% of state)
27.9K
$1.9B
Adrienne Bennett, spokesperson for Gov. Paul LePage (R): "We're in the process of analyzing what Medicaid expansion would mean for Maine." LePage is a fierce opponent of the ACA, and his administration has even said it believes the ruling gives it the authority to make cuts to Medicaid. Republicans control the state legislature.
YES
749.7K (13% of state)
174.5K
$9.1B
Gov. Martin O'Malley (D): "We remain as committed as ever to moving forward." Democrats control the state legislature.
YES
327.9K (5% of state)
10.4K
$2.1B
Gov. Deval Patrick (D): The Supreme Court ruling is "a victory for the American people." Democrats control the state legislature.
Leaning NO
1.3M (13% of state)
430.7K
$14.3B
Gov. Rick Snyder (R): "We're closely analyzing the impact ... It's not a decision that can be made immediately or lightly." Ari Adler, a spokesperson for House Speaker Jase Bolger (R): "We're reviewing that ... the federal government is offering short-term solutions that may create long-term problems."
YES
463.1K (9% of state)
132.5K
$7.8B
The state began implementing the expansion last year. Gov. Mark Dayton (D): The Supreme Court ruling "will be met with relief by the Minnesotans whose lives have already been improved by this law."
NO
555.3K (19% of state)
256.9K
$9.9B
Gov. Phil Bryant (R) doesn't intend to participate in the expansion, his office has said.
Leaning NO
853.3K (14% of state)
207.7K
$8.4B
Gov. Jay Nixon (D) has not said whether he backs the expansion, but Republicans who control the state legislature are opposed. House Majority Leader Tim Jones: "In this current economic time, we're not going to consider going down that path."
UNDECIDED
161.5K (17% of state)
38K
$2.2B
Gov. Brian Schweitzer (D), who leaves office in January, has not said whether he favors expanding Medicaid. Republicans control the state legislature.
Leaning NO
217.1K (12% of state)
50.4K
$2.3B
Gov. Dave Heineman (R) has said he'll resist efforts to expand Medicaid: "If this unfunded Medicaid expansion is implemented, state aid to education and funding for the University of Nebraska will be cut or taxes will be increased." Nebraska's legislators are non-partisan.
Leaning NO
552.4K (21% of state)
100.8K
$3.4B
Gov. Brian Sandoval (R): "As I sit here today, it wouldn't be my intention to opt in." Democrats control the state legislature.
Leaning NO
131.5K (10% of state)
34.6K
$1.2B
Gov. John Lynch (D), who is stepping down in January, has not said whether he favors expanding Medicaid. But House Speaker William O'Brien (R) is opposed: "We're not going to let the federal government try to hijack the states into paying for a slowly expanding Medicaid program that could cost us millions of dollars every year."
Leaning NO
1.3M (15% of state)
292.5K
$9B
Gov. Chris Christie (R): "We're taking a hard look at it. I doubt that we could expand Medicaid in New Jersey a whole lot more." Democrats control the state legislature.
UNDECIDED
424.4K (21% of state)
111.3K
$4.5B
Scott Darnell, a spokesperson for Gov. Susana Martinez (R): "The governor is reviewing today's Supreme Court decision." Republicans control the state Senate, and Democrats the House.
Leaning YES
2.8M (15% of state)
223.2K
$8B
Gov. Andrew Cuomo (D) hasn't said definitively whether he backs the expansion, but the state has begun implementing other parts of the ACA, and is expected to participate in the expansion.
UNDECIDED
1.6M (18% of state)
429.3K
$20.7B
Gov. Beverly Perdue (D) will review how the expansion would affect the state's Medicaid program, her office has said. Republicans control the state legislature.
Leaning NO
74.1K (12% of state)
17.2K
$595M
Gov. Jack Dalrymple (R) has said his staff is analyzing the court's ruling, but has also said the ACA is "wrong for North Dakota." Republicans control the state legislature.
Leaning NO
1.6M (14% of state)
462K
$17.1B
Gov. John Kasich (R): "We are very concerned that a sudden, dramatic increase in Medicaid spending could threaten Ohio's ability to pursue needed reforms in other areas." But he has not definitively ruled out participating. Republicans control the state legislature.
Leaning NO
638.5K (18% of state)
261.1K
$12.2B
Alex Weintz, a spokesperson for Gov. Mary Fallin (R): "No decision's been made yet regarding potential Medicaid expansion." Fallin is a staunch opponent of ACA. Republicans control the state legislature.
Leaning YES
637.9K (17% of state)
211.5K
$10.3B
Gov. John Kitzhaber (D): "We'll make a decision on whether or not to expand the Medicaid program really based on, I think, the resources we have available in the general fund." Kitzhaber also has said he expects lawmakers to approve the expansion. Democrats control the state Senate, while the House is evenly divided.
Leaning NO
1.4M (11% of state)
282K
$17.1B
Gov. Tom Corbett (R) "has not at this time made a formal decision regarding federal Medicaid expansion," his office said July 3. But Corbett said in a statement that the ACA "may turn out to be one of the largest tax increases in the history of our nation." Republicans control the state legislature.
YES
121.8K (12% of state)
29.1K
$1.6B
Steven Costantino, the state's secretary of health and human services: "The expansion is easy to do and makes sense." Gov. Lincoln Chaffee (I): "I have fully committed to ensuring Rhode Island is a national leader in implementing health reform." Democrats control the state legislature.
NO
843.6K (19% of state)
247.5K
$10.9B
Gov. Nikki Haley (R): The state "will NOT expand Medicaid."
Leaning NO
104.8K (13% of state)
18.6K
$717M
Joe Kafka, a spokesman for Gov. Dennis Daugaard (R), said no decision has yet been made, adding that expanding Medicaid "will be costly."" Republicans control the state legislature.
Leaning NO
933.7K (15% of state)
245.7K
$11.1B
Gov. Bill Haslam (R): "We don't really know what we're going to do, but the cost impact to the state is very significant." Republicans control the state legislature.
NO
6.2M (25% of state)
1.4M
$52.5B
Gov. Rick Perry (R): "We're not going to expand Medicaid."
Leaning NO
390.1K (14% of state)
78.3K
$4.1B
Gov. Gary Herbert (R) hasn't said definitively whether he backs expanding Medicaid, but in a statement he derided the ACA and its "massive, budget-busting Medicaid expansion." Republicans control the state legislature.
YES
58.7K (9% of state)
3.2K
$112M
Gov. Peter Shumlin (D) has said the state's Medicaid program already meets the ACA's requirements.
Leaning NO
1.04M (13% of state)
245.8K
$9.6B
Gov. Bob McDonnell (R) has said he'll review Virginia's options, but has also said the expansion would impose a "colossal" hit to the state's budget. Republicans control the state legislature.
YES
887.4K (13% of state)
189.5K
$8.3B
Gov. Christine Gregoire (D) "supports the Medicaid expansion and Washington will move forward," her office has said. Democrats control the state legislature.
UNDECIDED
245.8K (14% of state)
95.7K
$3.8B
Gov. Earl Ray Tomblin (D): "We're going to review the Supreme Court's ruling, and work with our federal delegation on how we move forward." Democrats control the state legislature.
Leaning NO
511.5K (9% of state)
127.9K
$4.3B
Gov. Scott Walker (R) at first said he "would not take any action to implement Obamacare." But on July 9, spokesman Cullen Werwie said it's "premature to comment on the Medicaid part, we have to evaluate its impact on Wisconsin citizens."
Leaning NO
88K (16% of state)
19.1K
$683M
Gov. Matt Mead (R) has said he'll review the ruling and the law, but added that "the ACA is not a good fit" for his state. Republicans control the state legislature.
When the Supreme Court upheld the Affordable Care Act (ACA) last month, it also ruled that states couldn’t be forced to expand Medicaid—turning one of the law’s key provisions for covering the uninsured into a choice states could make for themselves.
The map above lays out the state of play. It uses comments by state leaders to assess each state’s likelihood of participating in the expansion (it’s worth noting that in most states, the expansion would likely need to be approved by both the legislature and the governor, something the map’s assessment take into account). Using numbers from a widely cited study by the Kaiser Family Foundation (pdf), it shows how many uninsured people in each state would benefit, as well as how much federal money each state would be rejecting if it doesn’t proceed. As new developments affect the picture, we’ll keep updating the map.
Already, leaders in over the half the states have either flatly said they won’t participate in the expansion, or appear to be leaning against it. And many of those states are among those with the highest proportion of the uninsured. If those states stick to their guns, it would likely mean that millions of struggling Americans promised coverage under the ACA will be out of luck.
Some of the potential holdouts may ultimately come around. After all, states would spend only 2.8% more on Medicaid from 2014 to 2022 than they would have without the law, according to one study based on Congressional Budget Office (CBO) figures. And that doesn’t even take into account the savings states would realize in health-care costs for the uninsured. By opting out, states would be turning their noses up at a very good deal.
But one thing is clear: The battle over the ACA, far from being over, has just shifted to the states.
Several Republican governors have said they plan not to expand their states' Medicaid program under the Affordable Care Act. On The Rachel Maddow Show Monday, one former governor said failing to do so would be "gubernatorial malpractice."
Howard Dean said accepting federal money to expand Medicaid would not only help the uninsured, it would also jolt states' struggling economies.
"This is just stupidity if governors refuse this," said Dean, who served as governor of Vermont and came close to capturing the Democratic presidential nomination in 2004. "Because not only does it boost their healthcare sector and insure a lot of people, it raises their gross domestic product, because it increases spending by the private sector and the hospital sector in every aspect of the state's economy."
The Supreme Court ruled last week that states could not be penalized for refusing to expand Medicaid under the new law, potentially opening the door for Republican-led states to leave billions of federal dollars for that purpose on the table.
Dean predicted to guest-host Ezra Klein that even Texas, which has appeared among the most reluctant of all states to implement Obamacare, and which stands to receive more federal Medicaid dollars than any other state, will relent when push comes to shove.
"I don't care who the governor in Texas is, they're gonna take this money," said Dean. "It's $52 billion, and they have a really sophisticated network of hospitals, probably the third or fourth most sophisticated in the whole country ... If you think that the governor, whoever it is, whether Republican or Democrat, is gonna be able to turn down $52 billion and not be eaten alive by places like Baylor and UT Medical Center, you've got another thing coming."
Dean said he expects other red states to follow suit.
"South Carolina gets an 80 percent [federal] match," he continued. "For [Governor] Nikki Haley not to take that 80 percent from the federal government is gubernatorial malpractice. It just is. I mean, that's a hell of a lot of money coming into a state that isn't doing so well," he said.
