Which States Are Most Likely To Resist Medicaid Expansion?

A blog about business and economics.
June 30 2012 2:04 PM

Which States Are Most Likely To Resist Medicaid Expansion?

Assuming Barack Obama is re-elected in 2012 and the Affordable Care Act is implemented starting in 2014, which states are most likely to decline the federal government's offer to expand Medicaid on extremely generous terms?

In the very short term, the decision is likely to be based on idiosyncratic elements of local politics. Gov. Rick Perry of Texas has defined his political career in terms of sharp antagonism to the federal government, and Gov. Rick Scott of Florida has defined his political career in terms of sharp antagonism to the Affordable Care Act. But it's by no means clear that either of those men will be in office in 2015. Over the longer term, Medicaid expansion should be driven by structural factors rather than the peculiarities of any particular politician.

Advertisement

The way I see it playing out, in most places local health care providers—hospitals, doctors—plus the national pharmaceutical industry will exist as a powerful lobby in favor of expansion. More Medicaid equals more customers. Certain classes of low-wage employers should also favor expansion. That means the greatest opposition to expansion over the long term may come not from places like Texas but from the low-population states of the Plains. Why? Because those are the places most likely to be suffering from shortages of doctors and other health providers. In a place where people worry about provider shortages, Medicaid expansion won't do existing providers much good. And the existing set of insured people will worry that completely aside from financial issues, Medicaid expansion will mean fewer doctors' appointments and hospital beds to go around.

Matthew Yglesias is the executive editor of Vox and author of The Rent Is Too Damn High.

TODAY IN SLATE

Frame Game

Hard Knocks

I was hit by a teacher in an East Texas public school. It taught me nothing.

Chief Justice John Roberts Says $1,000 Can’t Buy Influence in Congress. Looks Like He’s Wrong.

After This Merger, One Company Could Control One-Third of the Planet's Beer Sales

Hidden Messages in Corporate Logos

If You’re Outraged by the NFL, Follow This Satirical Blowhard on Twitter

Sports Nut

Giving Up on Goodell

How the NFL lost the trust of its most loyal reporters.

How Can We Investigate Potential Dangers of Fracking Without Being Alarmist?

My Year as an Abortion Doula       

  News & Politics
Weigel
Sept. 15 2014 8:56 PM The Benghazi Whistleblower Who Might Have Revealed a Massive Scandal on his Poetry Blog
  Business
Moneybox
Sept. 15 2014 7:27 PM Could IUDs Be the Next Great Weapon in the Battle Against Poverty?
  Life
Outward
Sept. 15 2014 4:38 PM What Is Straight Ice Cream?
  Double X
The XX Factor
Sept. 15 2014 3:31 PM My Year As an Abortion Doula
  Slate Plus
Tv Club
Sept. 15 2014 11:38 AM The Slate Doctor Who Podcast: Episode 4  A spoiler-filled discussion of "Listen."
  Arts
Brow Beat
Sept. 15 2014 8:58 PM Lorde Does an Excellent Cover of Kanye West’s “Flashing Lights”
  Technology
Future Tense
Sept. 15 2014 4:49 PM Cheetah Robot Is Now Wireless and Gallivanting on MIT’s Campus
  Health & Science
Bad Astronomy
Sept. 15 2014 11:00 AM The Comet and the Cosmic Beehive
  Sports
Sports Nut
Sept. 15 2014 9:05 PM Giving Up on Goodell How the NFL lost the trust of its most loyal reporters.