Where the States Stand

Utah Governor Gary Herbert announced yesterday that his state will expand Medicaid, becoming the twenty-sixth state (plus the District of Columbia) to do so via the Affordable Care Act. The state’s legislative leaders are looking at options for just how to proceed, including exploring an approach similar to the so-called “private option” in Arkansas, which uses Medicaid funds to purchase private health insurance for low-income residents. Herbert is the eighth Republican governor to embrace expansion, as ideological rigidity is beginning to give way in the face of what remains a very good deal for states (not to mention the real consequences of saying no). 


The map above shows the states that have thus far moved forward with expansion, and demonstrates the remarkable story of the compromise approach in Arkansas, given the rest of the South. Of course, some in the Arkansas legislature hope to reverse course in the coming fiscal session and take Arkansas off the map. 

Utah joins Iowa and Pennsylvania as states looking to piggy-back off the Arkansas private option. ThinkProgress has more on Utah and zooms out:  


There have been whispers that GOP governors in Tennessee, Texas, and Louisiana may eventually come around to the private option.

In red states, knee-jerk opposition to Obamacare has clashed with the reality that millions of low-income residents are being forced to fend for themselves while hospitals that primarily serve the poor can’t afford to keep treating uninsured patients in perpetuity. At least five public hospitals have been shuttered in anti-expansion states like Georgia, North Carolina, and Virginia, with more closures and staffing cuts on the horizon. Poor and sick people who relied on these hospitals will have to journey as far as 40 miles for their medical care now.

Taxpayers in these states are also getting a raw deal since their tax dollars will be used to fund other states’ Medicaid expansions. A recent study by the Commonwealth Fund found that rejecting the expansion will cost taxpayers billions