Expanding Medicaid has been a very controversial issue since the kickoff of the ACA, with many red states rejecting the concept since its inception. But states that have refused to expand the Medicaid program may be facing tough new pressure from the private sector, which is getting a substantial financial lift from dollars flowing in to newly eligible Medicaid patients.
For example, hospital chain HCA Holdings Inc., the country's largest for-profit chain, recently reported it had stronger earnings in its second quarter than initially forecasted because notably fewer uninsured patients came through its hospitals' doors.
HCA attributes this partly to uptake in ACA policies, but noted that it also got an unexpectedly strong boost from Medicaid sign-ups possible under expansions in many states. HCA's profits jumped in part because of an overall 6.6% fall in the number of uninsured patients it treated—and a 48% drop in uninsured patients in the four states that expanded their Medicaid programs, the chain said.
As private healthcare organizations begin to discover just how good Medicaid expansion can be for them, they're likely to lobby their state legislatures hard to reconsider their Medicaid policies—and I'd argue that over time, they'll get their way. After all, it's one thing to refuse Medicaid expansion as a political stance, but it's another thing entirely to ignore the united voices of healthcare providers demanding that the state help them keep their doors open and make a decent profit.
Admittedly, they may face an uphill battle.
As of May, according to advocacy organization Families USA, 27 states had expanded Medicaid eligibility, making it accessible to approximately 10.5 million Americans who might otherwise have been unable to acquire insurance, the group calculates.
However, to date, 20 states have chosen not to expend Medicaid and four are in limbo, having not made the decision if they will make the expansion. Governors in these four states—Indiana, Pennsylvania, Utah and Virginia—are struggling with the idea of putting together an expansion package that will work.
Still, health systems have every reason to lobby as aggressively as they ever have to push the state legislatures into extending Medicaid benefits. I'd argue that there's a general sense in virtually every state that the status quo won't work for much longer—that it's just a matter of what politically palatable compromises can be made to cover more of the poor.
While red states may oppose the ACA and all it stands for, a hard push from the states' providers combined with growing consumer pressure will ultimately change hearts and minds on the Medicaid expansion issue. It's just a matter of time.