Those Republican governors who still refuse to participate in the Medicaid expansion may be inflicting long-term financial damage on their states. A new RAND study finds that not only will these states will pay out nearly $1 billion more in uncompensated care and forfeit several billion more in federal Medicaid dollars, but they will also have more uninsured residents. Some conservative governors have concluded that expanding Medicaid is the best option for both their constituents and their budgets, but others (Texas Governor Rick Perry, for instance) remain committed to blocking the expansion on ideological grounds.
The RAND probably won’t persuade any of these leaders to change course. Not in the short term, anyway. But once 2014 arrives and other states implement the expansion without much fuss, the holdouts may decide the practical benefits of joining them may outweigh any political considerations. And if they don’t, their beleaguered local hospitals and medical providers will ramp up their lobbying efforts. That kind of political pressure may be difficult to resist.