Study: Obamacare Expansion Would Dramatically Reduce Numbers Of Uninsured In Conservative States

[Igel]

9. A request for information.

We're told that the ACA would cover 90-100% of the cost of the Medicaid expansion to include eligible folk up to 133% of the poverty level. Usually that's "100% of the cost for the first three years."

I don't recall seeing that the ACA would cover 90-100% of each state's cost for increasing coverage to include all those below 133% of the poverty level.

But some states have Medicaid pegged at something like 30% of the poverty rate, with "full Medicaid coverage" being a lot more than that. Others have funding levels set to include 100% of those eligible for Medicaid. If the ACA covers *all* those newly eligible, then it would be paying 100% of the increase up to the current Federal maximum plus whatever the expansion would be. This seems unfair. It also makes turning down the money short-term silly, even if the politics of reducing the funding level when the Federal government backs off after 3 years are problematic. I assume that the ACA precludes a donut hole in the income levels covered.

But if the ACA only includes funding the expansion from the old 100% of maximum to 133% of the poverty level and not from current funding levels to 133% of the poverty level, then this would constitute a huge budget item for states with currently low Medicaid funding levels. It would make the Texan budget wars of a year ago seem picayune, and funding it would all but impose a state income tax on a population most of whom seems (key word here) to oppose an income tax.

So, does the ACA cover the cost from current levels, whatever they are, to 133% of the poverty level--or just the expansion from 100% of the current maximum Medicaid funding to 133% of the poverty level?