The Hole in Healthcare Coverage: States’ Rejection of Medicaid Expansion

Almost a year ago, I was working as a research intern at the National Institute of Health. It was during my lunch break when my friend and coworker peered over her smartphone to announce to the table that the Supreme Court had upheld the Affordable Care Act. Many of us had followed the debates and controversy surrounding the Affordable Care Act since President Obama signed it into law in 2010. And for the rest of the day, the excitement in the building was palpable as news of the ruling spread.

Ideally, the Affordable Care Act was indeed something to be excited about. It eliminates many gaps in healthcare, particularly amongst the uninsured. Notable changes to insurance coverage includes young adults’ eligibility to join their parents health plans, an end to exclusion of children and adults with pre-existing conditions, and a prohibition of lifetime or annual limits on benefits.

However, the Supreme Court ruling also struck down the law’s mandated expansion of Medicaid, a loophole that some states are now exploiting. With Wisconsin as the latest state legislature to reject the proposed Medicaid expansion, many of the country’s citizens with the lowest incomes would be among those left uninsured.

A handy illustration of how the hole created by rejection of Medicaid expansion would lie directly under the poorest.

Wisconsin Governor Scott Walker cited “fiscal uncertainty coming out of Washington, D.C.” among the reasons for his opposition to the Medicaid expansion, but Democrats view the act as another ploy in the GOP’s continued resistance of “Obamacare.” You can check where your state currently stands using this interactive map.

Regardless of the reasons, states like Texas, Georgia, Alabama, and Missouri, along with their rejection of Medicaid expansion limit the effectiveness of the Affordable Care Act. Their resistance also burdens those who are the poorest. And such effects illustrate a dire failure in our basic responsibility to care for those most in need.


Serena Yin graduated with a degree in English from Johns Hopkins University in 2013. She is joining the Washington Reading Corps to promote literacy in local schools. A New England native, she loves ballet, beaches, and hamburgers. When she’s not on the hunt for the nearest Starbucks, she’s working on realizing her lifelong dream of meeting J.K. Rowling.