Skip to content
Subscriber Only

Republican Governors May Pay Price for Refusing to Expand Medicaid Under Obamacare

The White House seems to see an opportunity to exact a political price from Rick Scott, Greg Abbott, and other Republicans who continue to resist.
Florida Governor Rick Scott

Florida Governor Rick Scott

Photographer: Joe Raedle/Getty Images

In 2012, the Supreme Court ruled that the federal government couldn’t force states to expand eligibility for their Medicaid programs under the Affordable Care Act. Since then, the Obama administration has looked for ways to persuade Republicans who have steadfastly opposed Obamacare to participate in this key component of the act. The biggest incentive is the law’s promise of federal funds to cover the whole cost of newly qualified Medicaid patients for three years, until 2016, and at least 90 percent of the costs thereafter. Nevertheless, 20 states have refused to ease access to their Medicaid rolls. A few have been able to eat their cake and have it, too: Because of special arrangements that predate Obamacare, four states that haven’t expanded Medicaid have been getting billions each year in extra funding to pay for the care of people who are uninsured.

That’s about to change. On April 14, the Centers for Medicare and Medicaid Services (CMS), which manages federal funding to the states for health programs, alerted Florida officials that CMS plans to let the $1.3 billion the state gets annually to help hospitals cover the cost of treating uninsured patients lapse at the end of June. “Uncompensated care pool funding should not pay for costs that would be covered in a Medicaid expansion,” CMS wrote in its letter, which it released to reporters.