States that don’t opt in to the Affordable Care Act’s medicaid expansion stand to lose money (in addition to putting their citizens’ health at risk)

We have posted frequently about the ramifications of the states' decisions to opt-in (or not) to the Affordable Care Act's massive medicaid expansion, including just a few days ago, when we noted the large number of states that have either decided not to opt in (19) or are still thinking about it (8).

A new study by Carter Price and Christine Eibner says that states that don't opt in not only will undermine the health of some of their neediest citizens, but will lose money by providing uncompensated care for some of the people who would have been covered by the medicaid if their states had accepted the expansion. Read the whole study, which is published in the journal Health Affairs. Here's the abstract:

The US Supreme Court’s ruling on the Affordable Care Act in 2012 allowed
states to opt out of the health reform law’s Medicaid
expansion. Since that ruling, fourteen governors
have announced that their states will not expand their Medicaid
We used the RAND COMPARE microsimulation to analyze
how opting out of Medicaid expansion would affect coverage and
and whether alternative policy options—such as
partial expansion of Medicaid—could cover as many people at lower costs
states. With fourteen states opting out, we
estimate that 3.6 million fewer people would be insured, federal
transfer payments
to those states could fall by $8.4 billion, and
state spending on uncompensated care could increase by $1 billion in
compared to what would be expected if all states
participated in the expansion. These effects were only partially
by alternative options we considered. We conclude
that in terms of coverage, cost, and federal payments, states would do
to expand Medicaid.

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