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When Obama administration defined the groundwork for the Patient Protection and Affordable Care Act, it defined a clause that would cover the needs of people who most require the benefits and protections of a health insurance plan. This clause was that of Medicaid expansion, which asked states to expand their Medicaid coverage to cover people up to 138 percent of the federal poverty line. However, not all states were in favor of this move, as these states felt that this would put undue stress on the already financially struggling Medicaid program. Almost all these states were GOP led.

After a fight in the Supreme Court that weighed this mandate of the ACA, the expansion was deemed optional, and ACA lost a major edge. In states that chose not to expand the Medicaid program, a gap in coverage was observed for people between 100 – 138 percent of the federal poverty line. Following this, states that did not move for the expansion faced several new challenges. One new challenge is wreaking havoc on the economics of Medicaid – hospitals have more unpaid medical bills in states which chose not to expand Medicaid.

As per a report available from the Department of Health and Human Services, the decline in the number of uninsured will benefit hospitals by as much as $5.7 billion in unpaid hospital bills. However, if you drill down into this number, the states that have expanded Medicaid are experiencing a better outcome. The 25 states that did the expansion will have about $4.2 billion less in unpaid bills, which is about a 25 percent decrease. On the other hand, the states that didn’t expand will have only $1.5 billion less in unpaid bills, which is a 9 percent decrease. As evident from the report, that is a stark absolute and relative decrease.

In simpler words, the report shows that there is a direct, explainable correlation between Medicaid expansion and the quality of health insurance coverage for that state. For instance, the report exhibits that a lesser number of people are going to hospitals without health insurance or any other means to pay for the treatment they seek. The decrease is all round, but it is more prominent and more substantial in states which decided to expand Medicaid.

Another takeaway from this report is that the expansion has had a direct effect on the number of uninsured in the state, especially in the low-income group. The study estimates that about 10.3 million people have newly acquired health insurance under Obamacare, and that 7.9 million more people have newly enrolled in Medicaid or the connected CHIP program after Obamacare rolled out. Another 7.3 million people have acquired health insurance under public exchanges through the law. Contrary to this, the states that decided not to go for Medicaid expansion have about 4.8 million uninsured, who would have otherwise been eligible for coverage under expanded Medicaid.

Amid this, hospitals are trapped in a precarious situation. Even after endorsing the ACA for ensuring that more people get health insurance and fewer patients are unable to pay for hospital care, they are stuck with large bills that they are unable to play. Hospital groups in Texas and Florida even tried to lobby for Medicaid expansion after the Supreme Court ruling came out last year, but to no avail. With such high amount of unpaid bills and available information making Medicaid expansion a viable option, hospitals are keeping their fingers crossed in the hopes of a Medicaid expansion in their state.

In the light of these new numbers and changing sentiments, some states are finally moving toward Medicaid expansion. Pennsylvania and New Hampshire are two of the new entrants in the Medicaid expanded state list, making the count 27 plus District of Columbia. The Obama administration is already trying to make more states sign on for expansion, and it looks like the available studies and collated data point to one single claim – Medicaid expansion can fill in the gaps left in states and help them realize the true worth of Obamacare. Collectively, the administration and available facts might be able to coerce even the most solid Republican states into expanding Medicaid in a short period of time from now.

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