Do states regret expanding Medicaid? Not much if at all

Congress has suspended efforts to repeal or replace the Patient Protection and Affordable Care Act, giving the 18 states that haven't expanded Medicaid more time to consider it. "The ACA’s established funding will pay for 90 percent of the costs of expanding Medicaid to cover people in households with incomes at or below 138 percent of the federal poverty level," Mark Hall writes for the Brookings Institution. "Previously, these 18 states declined to expand, in part because of concerns about their ability to predict and afford their 10 percent share of the costs." All the states are controlled by Republicans.

But with the ACA in its fifth year, states that didn't expand Medicaid can now see how it has performed in states that did expand. Hall curates a wide range of independent and government studies debunking arguments that Medicaid is a greater financial burden than the expansion states expected, and that Republican governors in at least five expansion states (Arkansas, Arizona, Michigan, Nevada and Ohio) continue to support expansion, "and several openly opposed recent congressional efforts to repeal expansion," Hall writes. And some states that haven't already expanded Medicaid may be tempted to do so with Republican-friendly provisions such as work requirements.

Medicaid is particularly critical to rural areas, though the low reimbursement rate for complicated obstetrical cases has contributed to many rural hospitals shuttering OB services and increased the risk to rural women and their babies.