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A year later, 13 governors still oppose Medicaid expansion

June 28, 2013

    Juliette Mullin, Daily Briefing

    When Republican governors first started saying they would opt out of Medicaid expansion in the wake of the Supreme Court's ruling on the Affordable Care Act (ACA), observers widely agreed that the GOP would come around and accept the federally funded expansion.

    True, some governors—including Florida's Rick Scott, a former health care executive and vocal ACA opponent—did just that, even if their legislatures fought them on it.

    But one year after the ruling, 13 governors have held strong in their opposition to the ACA and its Medicaid expansion. And they're running out of time to change their minds.

    Medicaid expansion—then and now

    The News Division of the Advisory Board has been tracking governors' stances on the expansion since the days after the June 28, 2012, ruling, which made Medicaid expansion optional and left the decision to expand in the hands of governors and state legislatures.

    In our first survey of the states, completed on July 5, four governors said they would not expand their state programs, and another eight said they were leaning against participating in the expansion.

    Our first map of the Medicaid expansion

    Since then, just five of those governors—Florida, New Jersey, Iowa, Missouri, and Nevada—have changed their tune and agreed to expand. (Although it's unclear how many of these governors will get expansion through their state legislatures.)

    Meanwhile, 12 other governors have joined the anti-expansion team, either saying they would not expand Medicaid or indicating that they were unlikely to do so. That brings the overall number of governors saying they will not expanding Medicaid—or indicating that they are unlikely to do so—to 19.

    Our current map of the Medicaid expansion

    States could still change their minds about expansion—either for 2014 or for later years. And states that had opposed a Medicaid expansion could warm up to the idea of an Arkansas-like deal.

    But one year after the Supreme Court ruling, as many legislative sessions are wrapping up for the year, we have yet to see the major position reversal that pundits expected.

    Want to know more about the ACA's coverage expansion?

    In 2014, the ACA's Medicaid expansion and health insurance exchanges will go live, expanding insurance to millions of Americans.  

    The insurance exchanges: Register for our July webconferences to learn everything you need to know about the insurance marketplaces before they begin enrolling patients on Oct. 1. For an immediate look, check out our new white paper.

    The Medicaid expansion: Listen to this on-demand webconference to learn how to manage your hospital's new Medicaid population. For a quick glance, check out the Daily Briefing's primer.

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