This map shows which states have taken up the Affordable Care Act's (ACA) opportunity to expand each state's Medicaid program to citizens earning 101-135% of the Federal Poverty Limit (FPL). The majority of states and DC are now participating with the Federal government picking up the entire tab for the expansion for the first year or so. Then the states will after a few years have to pay for 10% of the expansion and the Federal government will continue to pay 90% of the tab.
Several key points:
- If you are like me and live in a state whose governor and legislature has chosen not to expand Medicaid insurance, then you and your fellow citizens are paying taxes into the Federal government to support the expansion, but your state is not getting any of the direct benefits.
- By some estimates 8 million uninsured Americans were eligible for their states' Medicaid programs but were unaware or at least not enrolled. The media attention and efforts to sign people up for insurance, however, may be providing the indirect benefit of getting more people to sign up for Medicaid who are eligible.
- The ACA was designed for all the states to expand Medicaid to the poorest uninsured. People earning <101% of the FPL were already eligible for Medicaid. Those earning >135% up to 400% of the FPL get a subsidy to help them pay for private insurance purchased through the health insurance exchanges. Everyone must by law have insurance. So in states that did not expand Medicaid, these poorest of the uninsured must by law purchase insurance but do not get Medicaid ...and they get no subsidy. They are trapped in the "Medicaid donut hole" as some are calling it.