In most of the states where governors are rejecting or leaning against the expansion, the income level that disqualifies a parent from Medicaid is stunningly low. Only in New Jersey, where Gov. Chris Christie has said he’s leaning against the expansion, is Medicaid available to parents with incomes at the poverty line and slightly above. New Jersey will cover a parent making $24,645 in a family of three.
Most states base Medicaid eligibility for parents on household income and how it compares to the federal poverty level, which was $18,530 for a family of three in 2011, the year being used for easier state-by-state comparisons.
In Louisiana, the eligibility cutoff for a working parent is 25 percent of federal poverty, or $4,633 for a family of three. In Nevada, it’s 87 percent of the federal poverty level, or $16,121 for a family of three.
That’s been the range in states where governors are likely saying no to expanded Medicaid.
In contrast, states where governors have said they’ll expand Medicaid are more generous with working parents. The Medicaid eligibility cutoff ranges in those states from Washington’s $13,527 to Minnesota’s $39,840.
To be sure, some states with generous coverage for parents have been forced to cut back. Illinois, facing a financial crisis, ended coverage last month for more than 25,000 working parents. Even so, the state still covers working parents with incomes slightly higher than the poverty line.
The national health law’s Medicaid expansion would start covering all citizens in 2014 who make up to roughly $15,400 for an individual, $30,650 for a family of four.
The federal government will pay the full cost of the Medicaid expansion through 2016. After that, the states will only pick up 5 percent of the cost through 2019, and 10 percent of the cost thereafter.
So why would any governor say no to such a great deal?
These governors are in favor of smaller government. In principle, they don’t want the federal government to expand — even if that expansion would help their own citizens. And they say they don’t want their own states paying any more of the Medicaid tab even if it’s years down the road.
“We don’t need the federal government telling us what to do when it comes to meeting the needs of the citizens of our states,” Florida Gov. Rick Scott wrote recently in an opinion piece for U.S. News and World Report. “And we don’t need Washington putting states on the hook for future budget obligations.”
Also, many conservatives view Medicaid as a wasteful, highly flawed program, akin to no health coverage. Many doctors across the country won’t treat Medicaid patients because the payments they receive are so low.
When the Supreme Court ruled that states could opt out of the health law’s Medicaid expansion, it raised the chances for inequity at a time when more Americans have fallen from the middle class into poverty, said Isabel Sawhill, a senior fellow at the Brookings Institution.