A new study bolsters the case for expanding Medicaid in the 19 states that have still not taken advantage of one of the central provisions of the Affordable Care Act.
The study, which was led by two researchers at Harvard and MIT and published in Health Affairs, finds that states that expanded Medicaid have not seen increases in state spending on health care services for low-income people. Nor have they seen corresponding decreases in spending on other types of programs.
"Expansion is basically free," study co-author Jonathan Gruber, an MIT economist who helped craft the ACA, tells Kaiser Health News.
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The explanation for the finding is relatively simple: In the first three years of the Medicaid expansion, the federal government picked up 100 percent of the tab to provide health care to residents who would not be eligible under the state's former program.
2017 is the first year when the federal government will not pay the entirety of the expansion bill, requiring states to pay 5 percent of the cost. By 2020, states will have to pay for 10 percent of it.
Republican opponents of the expansion have argued that it would still eventually lead to increased state spending and that the federal government might eventually renege on its promise to pay 90 percent of the cost. In addition, many conservatives are ideologically opposed to the concept of expanding Medicaid and point out that federal dollars come from the same taxpayers as state government dollars.
As their party deals with its failure to fulfill its "repeal Obamacare" promise, GOP state legislators in a number of states have said it's time to accept the expansion.
Last month, the GOP-controlled legislature in Kansas voted in favor of expanding, but that move was thwarted by Gov. Sam Brownback's veto, which legislators fell just short of overriding. Brownback, who suffers from low approval ratings due largely to the state's poor fiscal situation, was bashed by members of his own party over the move.
In Utah, the GOP-dominated legislature agreed in February to a small-scale expansion of Medicaid.
In Maine, where state government is under split control, voters frustrated with Republican Gov. Paul LePage's refusal to expand Medicaid have taken matters into their own hands. They have gathered enough signatures to get the question put on the ballot this fall.
Medicaid expansion has also been one of the main issues of contention that has led to Republicans in Congress being unable to come up with a replacement for the ACA.
A number of Republicans in the Senate and House from states that have expanded do not want to see a large number of their constituents lose their new benefit, while conservatives, notably from states that haven't expanded, want to see the entire expansion scrapped.
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