January 17, 2013
Medicaid expansion under the Affordable Care Act is likely to be unevenly implemented, creating substantial gaps in coverage once the law takes full effect in January 2014, according to an analysis published Wednesday in the New England Journal of Medicine, Reuters reports.
For the analysis, researchers examined governors’ positions as they entered the last legislative session before the ACA takes full effect (Morgan, Reuters, 1/16). The study found that:
• The mayor of Washington, D.C., and 20 governors — including two Republicans and one independent — were likely to support expanding Medicaid in their state;
• 17 governors — including 15 Republicans — were currently undecided about the expansion; and
• 13 governors — all Republicans — opposed the expansion (NEJM analysis, 1/16).
The analysis also found that governors’ primary concerns were the potential budget implications of the expansion or simply an aversion to enrolling in a new government program.
Benjamin Sommers and Arnold Epstein, Harvard physicians and the authors of the study, said, “It now appears that [the ACA’s] 2014 coverage expansion will have large unintended gaps, as low-income adults in at least a dozen states remain ineligible for any kind of public subsidy for health insurance.”
Reuters notes that a governor’s position does not necessarily indicate whether a state will expand Medicaid because many states require the legislature’s consent. In addition, undecided governors are expected to make a decision on the Medicaid expansion as they develop their state budgets (Reuters, 1/16).