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As our readers will recall, under the Supreme Court's decision in NFIB v. Sebelius, the Affordable Care Act's very significant expansion of the Medicaid program will not operate in any state unless the state opts in. If a state does not opt in, its residents cannot benefit from the expansion.
Under the expansion, almost everyone with incomes at or below 133% of the federal poverty line is entitled to comprehensive government-provided health insurance. Without the expansion, entitlement ends at considerably lower income levels, and, generally, childless, non-disabled adults are not eligible at all. Under the ACA, the federal government funds the great majority of the expansion's cost.
So far, 31 states have opted for Medicaid expansion; 19 states are not currently considering expansion at all; and one state (Utah) is currently considering whether to opt in.
It's been well publicized that most states that have opted for expansion are located along the mid-Atlantic and west coasts, in the northeast and north central U.S., and in the southwest. Most southern and heartland states have stayed away. But when one actually looks at a Medicaid-expansion map (below), the geographic coverage differences by region seem starker. (Only one state that seceded from the Union -- Arkansas -- has opted in.)
If low-income people with Medicaid coverage are healthier than low-income people who lack insurance -- and that's the idea of ACA Medicaid expansion -- have we created (or are we further engraining) a nation divided geographically by the health of its people?