States have divided almost evenly on whether to expand Medicaid to millions more low-income Americans, many of them uninsured.
Many Republican governors or state legislatures have rejected expansion, saying that although the federal government will pick up most of the tab now, states could be left on the hook in the future.
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And although expansion aims for low-income people, "you're expanding coverage for graduate students and Starbucks baristas," says Edmund Haislmaier, senior research fellow at the Heritage Foundation's Center for Health Policy Studies.
Elaine Ryan, AARP vice president of state advocacy, sees it differently. In states that don't expand Medicaid, people with income below the poverty level are left without help paying for coverage. "The poorest in the state qualify for nothing," she says. Without coverage, those people will rack up more expensive tabs in emergency rooms that they can't pay. Or they will go untreated, letting a chronic illness fester and then, when eligible for Medicare, costing taxpayers more.
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