Pennsylvania has recently become the ninth state with a Republican governor to expand Medicaid. The Republican governors of Arizona, Iowa, Michigan, Nevada, New Jersey, New Mexico, North Dakota and Ohio have already expanded Medicaid in some form. Nineteen other states and the District of Columbia have also expanded Medicaid, leaving those who have not in a shrinking minority.
Pennsylvania Governor Tom Corbett will be implementing a modified program that allows the state to use money authorized by the Affordable Care Act to purchase private health insurance for poor adults. It’s not Medicaid per se, but will have the ultimate effect of insuring nearly half a million low-income adults. Pennsylvania currently has the fifth largest Medicaid-eligible population among states that had not already expanded Medicaid, and yet it is still only half of Texas’s Medicaid-eligible population. That is to say the expansion will have an enormous impact, but one that pales in comparison to what an expansion could do in Texas.
Not all of these states have accepted the same flavor of Medicaid expansion proposed by the Affordable Care Act, but are still insuring many more low-income people nonetheless. Iowa and Arkansas, like Pennsylvania, are also using private insurance to expand Medicaid. Indiana Governor Mike Pence is seeking to expand Medicaid through an existing state program. The governor of Tennessee, Republican Bill Haslam, recently announced that the state will soon submit its own alternative proposal to expand Medicaid, potentially covering 162,000 low-income uninsured people.
Even Wyoming and Utah – the two states in which President Obama is less popular than anywhere else in the nation – are in negotiations with the federal government to find Medicaid expansion options that work for their states.
While these other red states bury their grudges in order to do the right thing, Texas is leaving 1 million Texans uninsured and billions of dollars on the table, all while paying to expand Medicaid in other states.
There may be a light at the end of the tunnel. Recently Texas legislators – including Republicans – have begun meeting about Medicaid expansion options that might be able to pass a conservative smell test. There seems to be a growing recognition that there are ways to insure low-income people that don’t require governors to hand in their conservative credentials. But the longer we wait, the farther we fall behind.