Now that the Supreme Court has ruled in favor of the administration’s position in the ‘King v. Burwell’ case, supporting the legality of Affordable Care Act subsidies in all states, residents and legislators in states that have declined to expand Medicaid coverage are pondering what that ruling means to them.

Drafters of the ACA assumed all states would take advantage of the law’s offer to cover most or all of the cost of expanding Medicaid coverage to include all Americans whose income was below 138% of the federal poverty level. But only 29 states and the District of Columbia did so; 21 states declined, although two of these are considering an expansion of their Medicaid programs.

In Georgia,one the non-expansion states, about 300,000 residents have incomes too low for them to qualify for insurance subsidies but would have qualified for Medicaid, according to an article in The Augusta Chronicle.

With the ‘King’ case decided and that uncertainty about the future of the ACA removed, “it really is time to move on and make sure that [the ACA] works for all Georgians, and that means people who are currently in the coverage gap,” Cindy Zel­din, executive director of Georgians for a Healthy Future, told the newspaper’s reporter Tom Corwin.

In rural areas of Georgia, as much as 40% to 50% of residents have no health insurance at all, according to Jim Davis, CEO of University Hospital in Augusta.

“Because there is no Medi­caid expansion, we still have a tremendous amount of uninsured expense,” Davis told the newspaper, while hospitals are also seeing cuts in payments from Medi­care. “We’re getting the bad side of both things here and none of the upside. You’re starting to see rural hospitals fail. I think you are going to see a lot of that quickly.”

The federal government would provide about $3 billion to pay for the costs of expanding Medicaid, covering 100% of the cost in 2016 and 90% in subsequent years.
Opponents say Medicaid expansion would still be too costly, and argue that the federal government could reduce payments in later years, saddling Georgia and other expansion states with those costs.

The newspaper notes that the Georgia legislature was so opposed to expansion that it stripped the state’s governor of the power to decide on expanding Medicaid, leaving that decision solely in the hands of the legislature.

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