In the wake of the Supreme Court decision that largely upheld the Affordable Care Act and let states decide whether or not to expand their Medicaid programs, citizens from at least 25 states have started online petitions urging their governors and state legislators to accept the law's Medicaid expansion and develop their own health insurance exchanges rather than having the federal government do so.
A total of at least 123,214 people have signed petitions on SignOn.org, according to a Governing search of state-by-state petitions with the term "Affordable Care Act." The petitions with the largest number of signatures are generally from Republican-led states where officials have expressed concerns about implementing the federal health-care reform law. Most of the petitions on SignOn.org, however, are pushing progressive ideas and are started by liberal citizens and organizations such as Planned Parenthood and AFL-CIO.
Republican governors in Florida, Iowa, Kansas, Louisiana, Nebraska, Texas, South Carolina and Wisconsin have said they will not participate in the Medicaid expansion and/or create their own health exchange; while GOP governors in Alabama, Georgia, Indiana, Mississippi, Nevada and Virginia have indicated they're leaning in that direction, Stateline reported last week.
A petition pushing Florida to expand Medicaid and establish a health exchange has more than 24,000 signatures -- the most among the 25 states. The petition, directed to Gov. Rick Scott, states: "He turned down millions of dollars and refuses to set up insurance exchanges. The result: thousands in Florida will be deprived of medical care and the costs of providing care to people without insurance will keep getting moved onto you and me."
A Texas petition with more than 22,000 signatures reads: “We are demanding that the insurance exchanges be created and put into service to help the millions of Texans who are uninsured or underinsured.”
Texas has the highest rate of uninsured people -- about 5.8 million, according to a Governing analysis of Urban Institute data, and more than 40 percent of the state's uninsured would qualify for Medicaid, if the expansion is fully implemented.
Following the Court's ruling, Texas Gov. Rick Perry wrote a letter to U.S. Health and Human Services Secretary Kathleen Sebelius, stating that he would not expand Medicaid funds and would let the federal government create a health exchange for the state. “Neither a ‘state’ exchange nor the expansion of Medicaid under this program would result in better ‘patient protection’ or in more ‘affordable care,’” Perry wrote in the letter.
Nearly 2,000 citizens have signed a petition urging the Mississippi GOP to “drop their opposition to the Affordable Care Act and enact the provisions in a timely manner.” Mississippi has one of the nation's highest percentages of uninsured people who would qualify for Medicaid under the expansion (63.2 percent).
Gov. Phil Bryant has said he would not implement the expansion if it resulted in higher taxes or cuts to other programs. “Although I am continuing to review the ruling by the Supreme Court, I would resist any expansion of Medicaid that could result in significant tax increases or dramatic cuts to education, public safety and job creation," he said in a statement.
The Supreme Court ruled on June 28 that it was unconstitutional for the federal government to withhold existing Medicaid funding from states that do not comply with the ACA's Medicaid expansion, which increases eligibility for the program to all people within 133 percent of the federal poverty line.
As Governing has previously reported, states are also likely to face pressure from hospitals and other health-care providers to implement the law. They would otherwise be forced to provide uncompensated care to individuals who remain uninsured, which cost hospitals more than $39 billion in 2009.
The map below details each state's uninsured population that could be eligible for Medicaid and each state's expected spending for the ACA's Medicaid expansion. Darker states have higher percentages of uninsured residents who are potentially Medicaid eligible. Click a state for additional information.
Zoom out to view Alaska and Hawaii data.
SOURCE: Medicaid eligibility estimates obtained from Urban Institute analysis of American Community Survey and Integrated Public Use Microdata Series data. State spending figures obtained from Medicaid Coverage and Spending in Health Reform: National and State‐by‐State Results for Adults at or Below 133% FPL, published May 2010 by the Kaiser Family Foundation.