Ultimately every state will expand Medicaid, says UB health policy expert

BUFFALO, N.Y. – The Medicaid expansions that voters in Idaho, Nebraska and Utah passed this week, after their own state legislatures rejected them, didn’t surprise Nancy H. Nielsen, MD, PhD, senior associate dean for health policy at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, and former head of the American Medical Association.

“My prediction has been that ultimately every state will expand Medicaid,” said Nielsen. “It’s in the states’ interests and certainly in the interests of their citizens.”

So far, 33 states and the District of Columbia have expanded Medicaid. Maine’s voters had also voted to expand it, but former Gov. Paul LePage blocked it. This week, Maine’s governor-elect Janet Mills pledged to implement expansion. Nielsen said that objections raised by the states and some Republican governors have been about the cost of expanding Medicaid coverage.

“The reality is that about 94 percent of the cost of expanding coverage is picked up by the federal government, decreasing to 90 percent by 2020, so these new people on the Medicaid rolls will cost the state money but it’s a very small amount,” she said.

Nielsen pointed out that prior to passage of the Affordable Care Act, 19 percent of Americans didn’t have health insurance. She added that studies show that these expansions are helping patients with all of their medical needs, including some critical public health issues, such as opioid use disorder.

“There is nothing good about being uninsured and this is a way to get help for those who need it most,” she said.

She said more states will ask the Centers for Medicare and Medicaid Services for waivers, which will allow them to charge Medicaid recipients premiums or institute work requirements.

“Some states have put in place severely restrictive Medicaid eligibility criteria,” she added. “They’re hurting their citizens terribly.”