In an interview with Vox, President Barack Obama said that convincing Republican governors and state legislatures to expand Medicaid is the “biggest challenge” remaining for the Affordable Care Act.
Obama pointed out that Medicaid expansion was supposed to account for nearly half of the law’s coverage expansion, but the Supreme Court’s 2012 decision had undermined it by making expansion optional.
“The big problem we have right now with Obamacare is that it was designed to make sure that some subset of people qualified for Medicaid, and that’s how they were going to get coverage, and others were going to go into the exchanges because they had slightly higher incomes,” he said.
“And because of the decision of the Roberts court — that we couldn’t incentivize states to expand Medicaid the way we had originally intended — you’ve got a lot of really big states, you’ve got tens of millions of people who aren’t able to get their Medicaid coverage,” he continued. “And so there’s this gap. And that’s probably the biggest challenge for us.”
An estimated four million or so people have been left uncovered by the law because 20-plus states, including Florida and Texas, have not expanded Medicaid. However, Obama added, he has been encouraged by the willingness of some Republican governors, like Ohio’s John Kasich and Michigan’s Rick Snyder, to come around on Medicaid expansion.
“You’re starting to see Republican governors and Republican state legislatures realize that we’re cutting off our nose to spite our face,” he said. “To their credit, you’ve got folks like John Kasich in Ohio and Snyder in Michigan and now, most recently the governor up in Alaska, and others who are saying, ‘You know what? This is the right thing to do. Let’s go ahead and expand it.'”
