Ultimately Every State Will Expand Medicaid, Says Nielsen

Nancy H. Nielsen, MD, PhD.

Nancy H. Nielsen, MD, PhD

Published November 13, 2018

Nancy H. Nielsen, MD, PhD, says she is not surprised by the Medicaid expansions that voters in Idaho, Nebraska and Utah passed this week, after their own state legislatures rejected them.

“My prediction has been that ultimately every state will expand Medicaid,” notes Nielsen, senior associate dean for health policy and clinical professor of medicine.

“It’s in the states’ interests and certainly in the interests of their citizens.”

Objections Have Been About Expansion Costs

So far, 33 states and the District of Columbia have expanded Medicaid. Maine’s voters had also voted to expand it, but former Gov. Paul LePage blocked it. This week, Maine’s governor-elect Janet Mills pledged to implement expansion.

Nielsen —  former head of the American Medical Association — says that objections raised by the states and some Republican governors have been about the cost of expanding Medicaid coverage.

“The reality is that about 94 percent of the cost of expanding coverage is picked up by the federal government, decreasing to 90 percent by 2020, so these new people on the Medicaid rolls will cost the state money, but it’s a very small amount,” she says.

‘Nothing Good About Being Uninsured’

Nielsen points out that prior to passage of the Affordable Care Act, 19 percent of Americans didn’t have health insurance. She adds that studies show that these expansions are helping patients with all of their medical needs, including some critical public health issues, such as opioid use disorder.

“There is nothing good about being uninsured, and this is a way to get help for those who need it most,” she emphasizes.

She says more states will ask the Centers for Medicare and Medicaid Services for waivers, which will allow them to charge Medicaid recipients premiums or institute work requirements.

“Some states have put in place severely restrictive Medicaid eligibility criteria,” adds Nielsen. “They’re hurting their citizens terribly.”