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States that opt out of Medicaid expansion stand to lose billions

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3651 (Published 04 June 2013) Cite this as: BMJ 2013;346:f3651
  1. Michael McCarthy
  1. 1Seattle

US states that choose not to expand their Medicaid programs, as intended by the Affordable Care Act 2010, will give up billions in annual federal payments and face substantial bills for the cost of uncompensated care, concludes a study by the RAND Corporation.1 At the same time they would be denying access to health insurance to millions of their residents who otherwise would have been covered, it says.

Under the 2010 law Medicaid was to be expanded nationwide next year to provide health insurance to people above the poverty level but with an annual income below 138% of that level, about $15 400 (£10 000; €11 800) for an individual and $31 800 for a family of four.2

The federal government was to pay 100% of the cost of the new coverage to 2016. Thereafter the states’ …

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