The ACA requires most Americans to have some kind of coverage by January. The law's expansion of Medicaid, made optional by the U.S. Supreme Court last year, would open the program to an additional 20 million people, according to the CMS. The report estimated 18 million people would be added under the Medicaid expansion if it were implemented to all 50 states. The federal government would pay for the expanded coverage for the first three years, and for 90% of the costs after that.
Despite the numbers of low-income Americans who would benefit, only 23 states so far have agreed to expand Medicaid, which would cover those under age 65 with income up to 138% of the federal poverty level. Twenty-one states have declined to expand Medicaid, while six states have remained undecided.
Many states have gone through pitched political battles over the issue. In Maine, more than 15,000 of the state's low-income residents could lose Medicaid coverage beginning in January in large part because of the state's decision not to expand its program under ACA.
The Associated Press, via the Concord Monitor, reported that an additional 10,500 adults with no children and incomes less than $11,500 are expected to become ineligible as a result of state changes in its Medicaid program, despite being eligible under ACA criteria.
Maine's Republican governor vetoed a bill to expand Medicaid, citing what he claimed were the unsustainable long-term costs to the state of the program expansion.
More than 11,000 residents were removed from Medicaid between February and May. While many would be eligible for federal subsidies to help purchase private coverage on the new state insurance exchange in January, as many as 10,000 adults who stand to lose coverage as a part of state cuts to the program would not be eligible to receive subsidies.
In Missouri, the Republican-led Legislature blocked an initiative led by the state's Democratic governor to expand Medicaid that would provide health coverage for an estimated 250,000 low-income residents.
Similar efforts to expand the program have encountered roadblocks by legislatures in Ohio, North Carolina, Texas and Florida, while bills to pass expansion have been blocked by Republican governors in states such as Pennsylvania.
In Arizona, a law expanding Medicaid that was pushed through by Republican Gov. Jan Brewer has led to in-fighting between Brewer and members of her own party, who are seeking to repeal the measure through a ballot initiative this fall.