Resolution Opposing PPACA Medicaid Expansion


This Resolution urges states to reject Medicaid expansion that is permitted, but not required, in the federal Patient Protection and Affordable Care Act, and instead reform the existing Medicaid safety net to increase access to high-quality, affordable private health coverage.

Resolution Opposing PPACA Medicaid Expansion

Model Policy

WHEREAS, Only {insert number} states have governors and legislatures in agreement to optionally expand Medicaid up to all persons earning up to one hundred thirty-eight percent (138%) of the federal poverty level beginning January 1, 2014, as outlined in the Patient Protection and Affordable Care Act (PPACA); and

WHEREAS, The PPACA Medicaid expansion is largely funded with federal tax dollars, currently estimated by the Kaiser Commission on Medicaid and the Uninsured to total six hundred and fifty four billion dollars ($654,000,000,000) over the next ten years; and

WHEREAS, The Congressional Budget Office estimates that federal funding for Medicaid represents one-fourth (1/4) of the federal budget deficit this year, and will grow to one-half (1/2) of the federal budget deficit by 2015; and

WHEREAS, The federal debt currently totals sixteen trillion dollars ($16,000,000,000,000), and is rising by more than one trillion dollars ($1,000,000,000,000) per year; and

WHEREAS, The PPACA Medicaid expansion will place enormous pressure on state budgets, and according to the National Association of State Budget Officers, Medicaid has eclipsed K-12 education as the largest single share of state spending; and

WHEREAS, Adding new enrollees to the Medicaid program will crowd out other state funding priorities like building schools, hiring teachers, fixing roads, supporting law enforcement, and relieving  struggling businesses and families of high tax burdens; and

WHEREAS, Despite federal funding promises to cover at least ninety percent (90%) of Medicaid expansion costs in future years, President Obama’s FY 2012 and FY 2013 federal budgets proposed a “blended rate” that would dramatically increase states’ share of Medicaid expansion costs over time; and

WHEREAS, House Budget Chairman Paul Ryan’s FY 2014 budget eliminates most spending outlined within PPACA, including the enhanced federal match to states that expand Medicaid under PPACA; and

WHEREAS, Experiences from states that have already expanded Medicaid, such as Maine and Arizona, demonstrate that projected per-person costs and participation rates for the Medicaid expansion population are often dramatically underestimated, forcing policymakers to make up for these unexpected cost increases by capping Medicaid enrollment, eliminating Medicaid services, or reducing Medicaid provider rates; and

WHEREAS, the PPACA Medicaid expansion does little to address the chronic access and health outcomes associated with Medicaid, with Health Affairs reporting in 2011 that one-third (1/3) of doctors refuse to accept to new Medicaid patients, and studies published in numerous peer-reviewed journals, including Pediatrics, the Journal of the American Medical Association, the Annals of Emergency Medicine, the Annals of Surgery, and others suggesting that Medicaid patients have worse access and health outcomes than the privately-insured, and in some cases, fare worse than the uninsured; and

WHEREAS, Experiences from other states illustrate that expanding coverage will increase demand for medical services without substantially increasing supply, which in turn will exacerbate provider shortages, lengthen wait times, and increase use of emergency rooms for preventable conditions; and

WHEREAS, Provider shortages will disproportionately affect seniors, the group most likely to have one or more chronic conditions in need of more frequent care and the group the Centers for Medicare and Medicaid Services’ actuaries predict will “almost certainly face increasingly severe problems with access to care” as a result of PPACA; and

WHEREAS, The PPACA Medicaid expansion is defined as any state measure that would expand eligibility pursuant to Section 2001 of the PPACA.

THEREFORE BE IT RESOLVED THAT {insert state legislative body} rejects the PPACA Medicaid expansion in order to protect patients and taxpayers, and instead supports patient-centered reforms to the existing Medicaid safety net to increase access to affordable, high-quality private health insurance.

Approved by the ALEC Legislative Board of Directors June 15, 2013.