So, where do states stand on the Medicaid expansion?

Tue Jul 24, 2012 9:34 AM EDT

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

• 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.