The Cost of Saying "No"

A new report by Carter Price and Christine Eibner of the Rand Corporation confirms what many of us have been saying for months--the cost to states refusing to accept federal funds to expand their Medicaid programs will run in the billions of dollars.

"With fourteen states opting out, we estimate that 3.6 million fewer people would be insured, federal transfer payments to those states could fall by $8.4 billion, and state spending on uncompensated care could increase by $1 billion in 2016, compared to what would be expected if all states participated in the expansion." 

In short, states will receive less in federal funds but they will also have to spend more because uncompensated care costs will be higher. This is the point that is often overlooked by those opposing the Affordable Care Act--when uninsured people cannot afford to pay their health care bills, those costs are borne instead by providers (in the form of lower revenues), insured individuals (in the form of higher premiums), and taxpayers (in the form of higher spending for the uninsured). Health care, even when it isn't paid for by the sick, isn't ever free. According to this Rand Corp. study, in 2016 alone the 14 states that have refused to accept the federal funds will pay an additional $1 billion to cover these costs.

So there is a very real financial cost for states like Oklahoma when we reject federal funds to expand Medicaid. At a time when real state spending is still below pre-recession levels, when our teachers and firefighters are among the nation's lowest paid, can we really afford to say "no" to billions of dollars?