Has Medicaid expansion been adopted in your state?
Status of State Action on the Medicaid Expansion Decision
As of November, 2024
Critical Analysis
Find answers to the following questions using the visual above, any links below, your big brain, and your knowledge of American government and politics:
Medicaid is the nation's public health insurance program for people with low income. The Medicaid program covers more than 1 in 5 Americans. Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.On March 27, 2023, outgoing North Carolina Governor and professional news anchor impersonator, Roy Cooper signed into law legislation that would direct the state to expand Medicaid. Based on the amazingly stunning visual above, now that NC (the best state in the union) has expanded medicaid coverage, what number of states still have not adopted medicaid expansion?
Medicaid has become a major part of our health care system, with two-thirds of Americans having a connection to Medicaid. Public opinion polling shows Medicaid has broad support across political parties with 76% of Americans saying the strongly or mostly support Medicaid. Why do you think so many Americans support Medicaid?
Effective January 1, 2014 The Affordable Care Act’s (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($20,120 for an individual in 2023) and provided states with an enhanced federal matching rate (FMAP) for their expansion populations. Because the federal government pays 90% of the cost of this program most states initially paid the 10% and joined the medicaid expansion, others did not. Based on the life-alteringly wonderful visual above, roughly what percentage of all American states have now adopted expanded medicaid?
Based on the visual above, and the map of party affiliation by state (below)* draw a conclusion about the states that have not yet adopted medicaid expansion.
North Carolina’s Medicaid expansion ensured access to affordable health insurance coverage for more than 600,000 North Carolinians. Which increases access to health care— including mental health and substance use services— across the state, particularly in rural communities. Research shows that when states expand Medicaid, it saves lives. A study found that Medicaid expansion was associated with nearly 12 fewer deaths per 100,000 adults each year in expansion states. That is because people with health coverage are more likely to get preventative care, more likely to catch and treat diseases like cancer and heart disease early, and less likely to skip medications because of the cost. If you were governor Roy Cooper, explain whether you would have signed that medicaid expansion into law.
When Social Security first began it was ridiculed and shunned by many states. Over time social security became wildly popular and opposition to Social Security became a “third rail” in politics - meaning that a politician voting against Social Security, was like a person touching the electrified third rail of a subway: instant death. Based on that history and the visual below* explain whether eventually all states will accept Medicaid expansion - even Texas.
Make a connection between the data in the map above and the concept of federalism.
Robert Yates, probable author of Brutus 1, the Anti-Federalist manifesto, was concerned about a tyrannical government taking away the rights of states and individuals. Make a claim about Medicaid expansion from the perspective of an Anti-Federalist.
They say that federalism allows people to “vote with their feet.” If you lived in Colorado (which thanks to their Medicaid expansion has a very low rate of uninsured people) versus next-door-neighbor Wyoming (which thanks to their refusal to expand Medicaid) has more than double the rate of uninsured people, explain how likely you would be to move?
President Trump has not talked specifically about Medicaid in the current campaign, but his record as president and proposals from Republican groups include plans to repeal or weaken the ACA, cap and reduce Medicaid financing, and restrict Medicaid eligibility, with the overarching goal of reducing federal spending on Medicaid. Estimates of savings range widely, from a $4.5 trillion reduction over 10 years (over a 50% reduction) under a Republican FY 2025 budget proposal, to earlier Congressional Republican proposals that would have reduced Medicaid spending by 25% or one-third, to other proposals with smaller overall reductions but large shifts in spending across states. Reductions in federal spending generally shift risk and costs to states as well as enrollees and would likely increase the number of uninsured people. Do you think that the strong public support for Medicaid will stop Trump from reducing the program?
Write and Discuss
Take ten minutes to write about the question at the top of the page and then discuss with your classmates.
Act on your Learning
Contact a member of your state legislature and ask them if they voted to expand Medicaid. Let them know whether you believe your state should expand Medicaid or not.
Get Creative
Imagine you were in charge of picking the mascot for all the states that did not expand Medicaid. What mascot would it be?
Learning Extension*
Check out this interactive map from the Kaiser Family Foundation about insurance rates in each state.
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