So, where do states stand on the Medicaid expansion?

Updated
By The Cycle Staff
So, where do states stand on the Medicaid expansion?
So, where do states stand on the Medicaid expansion?

State by state positions on Medicaid expansion under ACASelect a state for details

  • Alabama

    Leaning NO

  • Population Uninsured

    744.1K (16% of state)

  • Uninsured eligible for expanded Medicaid

    244.8K

  • Federal money available for Medicaid (through 2019)

    $10.3B

Jennifer Ardis, a spokeswoman for Gov. Robert Bentley (R): “We don’t know if the state can afford it. We need to study the full implications of the ruling.” Bentley called the ACA “the single worst piece of legislation to come out of Congress.”

  • Alaska

    Leaning NO

  • Population Uninsured

    121.8K (18% of state)

  • Uninsured eligible for expanded Medicaid

    33.1K

  • Federal money available for Medicaid (through 2019)

    $2B

Gov. Sean Parnell (R): “We will do everything we can in Alaska to limit the impact of Congress’ decision to pass this tax increase to Alaskans.”

  • Arizona

    Leaning NO

  • Population Uninsured

    1.26M (19% of state)

  • Uninsured eligible for expanded Medicaid

    81.1K

  • Federal money available for Medicaid (through 2019)

    $2B

Gov. Jan Brewer (R) has not said whether she’ll support expanding Medicaid, but called the ACA a “fiscal and regulatory nightmare.” House Speaker Andy Tobin (R) is opposed: “I don’t see us going along with the expansion if it’s not mandated.”

  • Arkansas

    Leaning YES

  • Population Uninsured

    540.3K (19% of state)

  • Uninsured eligible for expanded Medicaid

    154.8K

  • Federal money available for Medicaid (through 2019)

    $9.4B

Gov. Mike Beebe (D): “It’d take a pretty dang strong argument for me to say no to those people.” Democrats control the state legislature.

  • California

    YES

  • Population Uninsured

    7.16M (19% of state)

  • Uninsured eligible for expanded Medicaid

    1.4M

  • Federal money available for Medicaid (through 2019)

    $44.7B

Gov. Jerry Brown (D): The Supreme Court ruling “removes the last roadblock to fulfilling President Obama’s historic plan to bring health care to millions of uninsured citizens.” Democrats control the state legislature.

  • Colorado

    UNDECIDED

  • Population Uninsured

    688.7K (14% of state)

  • Uninsured eligible for expanded Medicaid

    166.5K

  • Federal money available for Medicaid (through 2019)

    $5.9B

Lorez Meinhold, health-policy director for Gov. John Hickenlooper (D): “It’s premature to answer that question.” Democrats control the state Senate, Republicans the House.

  • Connecticut

    YES

  • Population Uninsured

    385.6K (11% of state)

  • Uninsured eligible for expanded Medicaid

    75.9K

  • Federal money available for Medicaid (through 2019)

    $4.7B

In June 2010, the state became the first to approve the expansion.

  • Washington, D.C.

    YES

  • Population Uninsured

    74.7K (12% of state)

  • Uninsured eligible for expanded Medicaid

    15.3K

  • Federal money available for Medicaid (through 2019)

    $902M

The District has already begun to implement the expansion.

  • Delaware

    UNDECIDED

  • Population Uninsured

    107.1K (12% of state)

  • Uninsured eligible for expanded Medicaid

    7.9K

  • Federal money available for Medicaid (through 2019)

    $387M

The state has asked the Obama administration for more information about the cost of the expansion. Gov. Jack Markell (D): “Before we decide whether to choose that option, it seems prudent to get greater clarity and certainty from the federal government.” Democrats control the state legislature.

  • Florida

    NO

  • Population Uninsured

    3.9M (21% of state)

  • Uninsured eligible for expanded Medicaid

    683.5K

  • Federal money available for Medicaid (through 2019)

    $20.1B

Office of Gov. Rick Scott (R): “Florida will opt out of spending approximately $1.9 billion more taxpayer dollars required to implement a massive entitlement expansion of the Medicaid program.”

  • Georgia

    Leaning NO

  • Population Uninsured

    1.9M (20% of state)

  • Uninsured eligible for expanded Medicaid

    479.1K

  • Federal money available for Medicaid (through 2019)

    $14.6B

Gov. Nathan Deal (R) said the state would be in a “holding pattern” until the election, but a spokesperson said the expansion would cost “money we don’t have.” Republicans control the state legislature.

  • Hawaii

    YES

  • Population Uninsured

    94.5K (8% of state)

  • Uninsured eligible for expanded Medicaid

    42.4K

  • Federal money available for Medicaid (through 2019)

    $3B

The state has already begun implementing the expansion. Gov. Neil Abercrombie (D): “The Affordable Care Act is our ally in Hawaii to provide health care for everyone.”

  • Idaho

    Leaning NO

  • Population Uninsured

    262.4K (17% of state)

  • Uninsured eligible for expanded Medicaid

    59.1K

  • Federal money available for Medicaid (through 2019)

    $2.4B

Gov. Butch Otter (R) has yet to take a definitive stance on the expansion, but called the ACA “bad for America from the beginning.” Republicans control the state legislature.

  • Illinois

    YES

  • Population Uninsured

    1.9M (15% of state)

  • Uninsured eligible for expanded Medicaid

    429.3K

  • Federal money available for Medicaid (through 2019)

    $19.3B

Gov. Pat Quinn (D): “The state of Illinois is going forward with the president … to expand using Medicaid.” Democrats control the state legislature.

  • Indiana

    Leaning NO

  • Population Uninsured

    864.4K (14% of state)

  • Uninsured eligible for expanded Medicaid

    215.8K

  • Federal money available for Medicaid (through 2019)

    $8.5B

Gov. Mitch Daniels (R), who steps down in January, hasn’t said definitively whether he supports the expansion, but called the ACA “wildly misguided.” State Senate leader David Long (R) said the state can avoid a tax increase by “opting out of Obamacare’s Medicaid mandate, which we will certainly do.”

  • Iowa

    Leaning NO

  • Population Uninsured

    345K (12% of state)

  • Uninsured eligible for expanded Medicaid

    74.5K

  • Federal money available for Medicaid (through 2019)

    $2.8B

Gov. Terry Branstad (R): It’s “doubtful” Iowa will expand Medicaid. Democrats control the state Senate, Republicans the House.

  • Kansas

    Leaning NO

  • Population Uninsured

    351K (13% of state)

  • Uninsured eligible for expanded Medicaid

    89.3K

  • Federal money available for Medicaid (through 2019)

    $3.5B

Sherriene Jones-Sontag, a spokesperson for Gov. Sam Brownback (R): “He will wait until after the November elections before making any decisions related to ObamaCare.” Brownback has said that “[s]topping ObamaCare is now in the hands of the American people. It begins with electing a new president this fall.” Republicans control the state legislature.

  • Kentucky

    UNDECIDED

  • Population Uninsured

    659.9K (15% of state)

  • Uninsured eligible for expanded Medicaid

    250.7K

  • Federal money available for Medicaid (through 2019)

    $11.9B

Gov. Steve Beshear (D): “We continue to review the Supreme Court’s opinion, particularly on the Medicaid portion of the Affordable Care Act to determine what our options may be.” Republicans, who control the state Senate, have called the eventual cost of the expansion “unsustainable.” Democrats control the House and back the expansion.

  • Louisiana

    NO

  • Population Uninsured

    765.8K (17% of state)

  • Uninsured eligible for expanded Medicaid

    277.7K

  • Federal money available for Medicaid (through 2019)

    $7.3B

Gov. Bobby Jindal (R): “I don’t think it makes sense … I think it makes more sense to do everything we can to elect Mitt Romney to repeal Obamacare.” Republicans control the state legislature.

  • Maine

    Leaning NO

  • Population Uninsured

    125.6K (10% of state)

  • Uninsured eligible for expanded Medicaid

    27.9K

  • Federal money available for Medicaid (through 2019)

    $1.9B

Adrienne Bennett, spokesperson for Gov. Paul LePage (R): “We’re in the process of analyzing what Medicaid expansion would mean for Maine.” LePage is a fierce opponent of the ACA, and his administration has even said it believes the ruling gives it the authority to make cuts to Medicaid. Republicans control the state legislature.

  • Maryland

    YES

  • Population Uninsured

    749.7K (13% of state)

  • Uninsured eligible for expanded Medicaid

    174.5K

  • Federal money available for Medicaid (through 2019)

    $9.1B

Gov. Martin O’Malley (D): “We remain as committed as ever to moving forward.” Democrats control the state legislature.

  • Massachusetts

    YES

  • Population Uninsured

    327.9K (5% of state)

  • Uninsured eligible for expanded Medicaid

    10.4K

  • Federal money available for Medicaid (through 2019)

    $2.1B

Gov. Deval Patrick (D): The Supreme Court ruling is “a victory for the American people.” Democrats control the state legislature.

  • Michigan

    Leaning NO

  • Population Uninsured

    1.3M (13% of state)

  • Uninsured eligible for expanded Medicaid

    430.7K

  • Federal money available for Medicaid (through 2019)

    $14.3B

Gov. Rick Snyder (R): “We’re closely analyzing the impact … It’s not a decision that can be made immediately or lightly.” Ari Adler, a spokesperson for House Speaker Jase Bolger (R): “We’re reviewing that … the federal government is offering short-term solutions that may create long-term problems.”

  • Minnesota

    YES

  • Population Uninsured

    463.1K (9% of state)

  • Uninsured eligible for expanded Medicaid

    132.5K

  • Federal money available for Medicaid (through 2019)

    $7.8B

The state began implementing the expansion last year. Gov. Mark Dayton (D): The Supreme Court ruling “will be met with relief by the Minnesotans whose lives have already been improved by this law.”

  • Mississippi

    NO

  • Population Uninsured

    555.3K (19% of state)

  • Uninsured eligible for expanded Medicaid

    256.9K

  • Federal money available for Medicaid (through 2019)

    $9.9B

Gov. Phil Bryant (R) doesn’t intend to participate in the expansion, his office has said.

  • Missouri

    Leaning NO

  • Population Uninsured

    853.3K (14% of state)

  • Uninsured eligible for expanded Medicaid

    207.7K

  • Federal money available for Medicaid (through 2019)

    $8.4B

Gov. Jay Nixon (D) has not said whether he backs the expansion, but Republicans who control the state legislature are opposed. House Majority Leader Tim Jones: “In this current economic time, we’re not going to consider going down that path.”

  • Montana

    UNDECIDED

  • Population Uninsured

    161.5K (17% of state)

  • Uninsured eligible for expanded Medicaid

    38K

  • Federal money available for Medicaid (through 2019)

    $2.2B

Gov. Brian Schweitzer (D), who leaves office in January, has not said whether he favors expanding Medicaid. Republicans control the state legislature.

  • Nebraska

    Leaning NO

  • Population Uninsured

    217.1K (12% of state)

  • Uninsured eligible for expanded Medicaid

    50.4K

  • Federal money available for Medicaid (through 2019)

    $2.3B

Gov. Dave Heineman (R) has said he’ll resist efforts to expand Medicaid: “If this unfunded Medicaid expansion is implemented, state aid to education and funding for the University of Nebraska will be cut or taxes will be increased.” Nebraska’s legislators are non-partisan.

  • Nevada

    Leaning NO

  • Population Uninsured

    552.4K (21% of state)

  • Uninsured eligible for expanded Medicaid

    100.8K

  • Federal money available for Medicaid (through 2019)

    $3.4B

Gov. Brian Sandoval (R): “As I sit here today, it wouldn’t be my intention to opt in.” Democrats control the state legislature.

  • New Hampshire

    Leaning NO

  • Population Uninsured

    131.5K (10% of state)

  • Uninsured eligible for expanded Medicaid

    34.6K

  • Federal money available for Medicaid (through 2019)

    $1.2B

Gov. John Lynch (D), who is stepping down in January, has not said whether he favors expanding Medicaid. But House Speaker William O’Brien (R) is opposed: “We’re not going to let the federal government try to hijack the states into paying for a slowly expanding Medicaid program that could cost us millions of dollars every year.”

  • New Jersey

    Leaning NO

  • Population Uninsured

    1.3M (15% of state)

  • Uninsured eligible for expanded Medicaid

    292.5K

  • Federal money available for Medicaid (through 2019)

    $9B

Gov. Chris Christie (R): “We’re taking a hard look at it. I doubt that we could expand Medicaid in New Jersey a whole lot more.” Democrats control the state legislature.

  • New Mexico

    UNDECIDED

  • Population Uninsured

    424.4K (21% of state)

  • Uninsured eligible for expanded Medicaid

    111.3K

  • Federal money available for Medicaid (through 2019)

    $4.5B

Scott Darnell, a spokesperson for Gov. Susana Martinez (R): “The governor is reviewing today’s Supreme Court decision.” Republicans control the state Senate, and Democrats the House.

  • New York

    Leaning YES

  • Population Uninsured

    2.8M (15% of state)

  • Uninsured eligible for expanded Medicaid

    223.2K

  • Federal money available for Medicaid (through 2019)

    $8B

Gov. Andrew Cuomo (D) hasn’t said definitively whether he backs the expansion, but the state has begun implementing other parts of the ACA, and is expected to participate in the expansion.

  • North Carolina

    UNDECIDED

  • Population Uninsured

    1.6M (18% of state)

  • Uninsured eligible for expanded Medicaid

    429.3K

  • Federal money available for Medicaid (through 2019)

    $20.7B

Gov. Beverly Perdue (D) will review how the expansion would affect the state’s Medicaid program, her office has said. Republicans control the state legislature.

  • North Dakota

    Leaning NO

  • Population Uninsured

    74.1K (12% of state)

  • Uninsured eligible for expanded Medicaid

    17.2K

  • Federal money available for Medicaid (through 2019)

    $595M

Gov. Jack Dalrymple (R) has said his staff is analyzing the court’s ruling, but has also said the ACA is “wrong for North Dakota.” Republicans control the state legislature.

  • Ohio

    Leaning NO

  • Population Uninsured

    1.6M (14% of state)

  • Uninsured eligible for expanded Medicaid

    462K

  • Federal money available for Medicaid (through 2019)

    $17.1B

Gov. John Kasich (R): “We are very concerned that a sudden, dramatic increase in Medicaid spending could threaten Ohio’s ability to pursue needed reforms in other areas.” But he has not definitively ruled out participating. Republicans control the state legislature.

  • Oklahoma

    Leaning NO

  • Population Uninsured

    638.5K (18% of state)

  • Uninsured eligible for expanded Medicaid

    261.1K

  • Federal money available for Medicaid (through 2019)

    $12.2B

Alex Weintz, a spokesperson for Gov. Mary Fallin (R): “No decision’s been made yet regarding potential Medicaid expansion.” Fallin is a staunch opponent of ACA. Republicans control the state legislature.

  • Oregon

    Leaning YES

  • Population Uninsured

    637.9K (17% of state)

  • Uninsured eligible for expanded Medicaid

    211.5K

  • Federal money available for Medicaid (through 2019)

    $10.3B

Gov. John Kitzhaber (D): “We’ll make a decision on whether or not to expand the Medicaid program really based on, I think, the resources we have available in the general fund.” Kitzhaber also has said he expects lawmakers to approve the expansion. Democrats control the state Senate, while the House is evenly divided.

  • Pennsylvania

    Leaning NO

  • Population Uninsured

    1.4M (11% of state)

  • Uninsured eligible for expanded Medicaid

    282K

  • Federal money available for Medicaid (through 2019)

    $17.1B

Gov. Tom Corbett (R) “has not at this time made a formal decision regarding federal Medicaid expansion,” his office said July 3. But Corbett said in a statement that the ACA “may turn out to be one of the largest tax increases in the history of our nation.” Republicans control the state legislature.

  • Rhode Island

    YES

  • Population Uninsured

    121.8K (12% of state)

  • Uninsured eligible for expanded Medicaid

    29.1K

  • Federal money available for Medicaid (through 2019)

    $1.6B

Steven Costantino, the state’s secretary of health and human services: “The expansion is easy to do and makes sense.” Gov. Lincoln Chaffee (I): “I have fully committed to ensuring Rhode Island is a national leader in implementing health reform.” Democrats control the state legislature.

  • South Carolina

    NO

  • Population Uninsured

    843.6K (19% of state)

  • Uninsured eligible for expanded Medicaid

    247.5K

  • Federal money available for Medicaid (through 2019)

    $10.9B

Gov. Nikki Haley (R): The state “will NOT expand Medicaid.”

  • South Dakota

    Leaning NO

  • Population Uninsured

    104.8K (13% of state)

  • Uninsured eligible for expanded Medicaid

    18.6K

  • Federal money available for Medicaid (through 2019)

    $717M

Joe Kafka, a spokesman for Gov. Dennis Daugaard (R), said no decision has yet been made, adding that expanding Medicaid “will be costly.”” Republicans control the state legislature.

  • Tennessee

    Leaning NO

  • Population Uninsured

    933.7K (15% of state)

  • Uninsured eligible for expanded Medicaid

    245.7K

  • Federal money available for Medicaid (through 2019)

    $11.1B

Gov. Bill Haslam (R): “We don’t really know what we’re going to do, but the cost impact to the state is very significant.” Republicans control the state legislature.

  • Texas

    NO

  • Population Uninsured

    6.2M (25% of state)

  • Uninsured eligible for expanded Medicaid

    1.4M

  • Federal money available for Medicaid (through 2019)

    $52.5B

Gov. Rick Perry (R): “We’re not going to expand Medicaid.”

  • Utah

    Leaning NO

  • Population Uninsured

    390.1K (14% of state)

  • Uninsured eligible for expanded Medicaid

    78.3K

  • Federal money available for Medicaid (through 2019)

    $4.1B

Gov. Gary Herbert (R) hasn’t said definitively whether he backs expanding Medicaid, but in a statement he derided the ACA and its “massive, budget-busting Medicaid expansion.” Republicans control the state legislature.

  • Vermont

    YES

  • Population Uninsured

    58.7K (9% of state)

  • Uninsured eligible for expanded Medicaid

    3.2K

  • Federal money available for Medicaid (through 2019)

    $112M

Gov. Peter Shumlin (D) has said the state’s Medicaid program already meets the ACA’s requirements.

  • Virginia

    Leaning NO

  • Population Uninsured

    1.04M (13% of state)

  • Uninsured eligible for expanded Medicaid

    245.8K

  • Federal money available for Medicaid (through 2019)

    $9.6B

Gov. Bob McDonnell (R) has said he’ll review Virginia’s options, but has also said the expansion would impose a “colossal” hit to the state’s budget. Republicans control the state legislature.

  • Washington

    YES

  • Population Uninsured

    887.4K (13% of state)

  • Uninsured eligible for expanded Medicaid

    189.5K

  • Federal money available for Medicaid (through 2019)

    $8.3B

Gov. Christine Gregoire (D) “supports the Medicaid expansion and Washington will move forward,” her office has said. Democrats control the state legislature.

  • West Virginia

    UNDECIDED

  • Population Uninsured

    245.8K (14% of state)

  • Uninsured eligible for expanded Medicaid

    95.7K

  • Federal money available for Medicaid (through 2019)

    $3.8B

Gov. Earl Ray Tomblin (D): “We’re going to review the Supreme Court’s ruling, and work with our federal delegation on how we move forward.” Democrats control the state legislature.

  • Wisconsin

    Leaning NO

  • Population Uninsured

    511.5K (9% of state)

  • Uninsured eligible for expanded Medicaid

    127.9K

  • Federal money available for Medicaid (through 2019)

    $4.3B

Gov. Scott Walker (R) at first said he “would not take any action to implement Obamacare.” But on July 9, spokesman Cullen Werwie said it’s “premature to comment on the Medicaid part, we have to evaluate its impact on Wisconsin citizens.”

  • Wyoming

    Leaning NO

  • Population Uninsured

    88K (16% of state)

  • Uninsured eligible for expanded Medicaid

    19.1K

  • Federal money available for Medicaid (through 2019)

    $683M

Gov. Matt Mead (R) has said he’ll review the ruling and the law, but added that “the ACA is not a good fit” for his state. Republicans control the state legislature.

  • Key:
  • Yes
  • Leaning yes
  • No
  • Leaning no
  • Undecided

When the Supreme Court upheld the Affordable Care Act (ACA) last month, it also ruled that states couldn’t be forced to expand Medicaid—turning one of the law’s key provisions for covering the uninsured into a choice states could make for themselves.

The map above lays out the state of play. It uses comments by state leaders to assess each state’s likelihood of participating in the expansion (it’s worth noting that in most states, the expansion would likely need to be approved by both the legislature and the governor, something the map’s assessment take into account). Using numbers from a widely cited study by the Kaiser Family Foundation (pdf), it shows how many uninsured people in each state would benefit, as well as how much federal money each state would be rejecting if it doesn’t proceed. As new developments affect the picture, we’ll keep updating the map.

Already, leaders in over the half the states have either flatly said they won’t participate in the expansion, or appear to be leaning against it. And many of those states are among those with the highest proportion of the uninsured. If those states stick to their guns, it would likely mean that millions of struggling Americans promised coverage under the ACA will be out of luck.

Some of the potential holdouts may ultimately come around. After all, states would spend only 2.8% more on Medicaid from 2014 to 2022 than they would have without the law, according to one study based on Congressional Budget Office (CBO) figures. And that doesn’t even take into account the savings states would realize in health-care costs for the uninsured. By opting out, states would be turning their noses up at a very good deal.

But one thing is clear: The battle over the ACA, far from being over, has just shifted to the states. 

Affordable Care Act and Medicaid

So, where do states stand on the Medicaid expansion?

Updated