A recent article published by the New England Journal of Medicine, U.S. Governors and the Medicaid Expansion – No Quick Resolution in Sight, analyzed the views expressed by governors regarding Medicaid expansion in accordance with the Affordable Care Act (ACA) to identify themes and trends both before and after the presidential election. The question is whether states will participate in the expansion of Medicaid eligibility to include all adults with family incomes at or below 138% of the federal poverty level.
Before the election, 10 governors opposed expansion, 15 supported expansion, and the majority (26 governors) were undecided. (See Table 1). Initially it was thought that there would be more clarity regarding states’ positions after the elections. However, that was not the case. As of January 2013, 15 of the 26 undecided governors remained undecided. There was some movement: 6 governors newly announced their support, and 2 previously opposed became undecided. Nonetheless, 17 governors, including Pennsylvania and New Jersey governors, remain undecided after the election, and as a result, low-income adults in those undecided states will remain ineligible for any public subsidy for health insurance. There is concern history will repeat itself, and just like states delayed participation when Medicaid was first enacted in 1965, states might once again delay, putting millions of Americans and the fate of the ACA at risk.