Issues ››› Medicaid
  • Media Fail To Explain The Impact of HHS Nominee Tom Price’s Health Care Agenda

    ››› ››› CAT DUFFY

    Major newspapers gave little attention to the harmful impact Rep. Tom Price’s (R-GA) policies would have on the American health care system when discussing his expected nomination to serve as Secretary of the Department of Health and Human Services (HHS) in a future Trump administration. However, experts agree that Price’s preferred positions on the Affordable Care Act (ACA), Medicare and Medicaid, and reproductive health care access would harm millions of Americans.

  • James O’Keefe Is Still Not a Journalist

    ››› ››› PAM VOGEL

    Since 2009, self-described “guerilla journalist” James O’Keefe has repeatedly embarrassed himself while attempting to launch undercover stings targeting government agencies, media outlets, and  liberal organizations and institutions.

  • New Hampshire Newspaper Pushes Super PAC Ad That Even Republicans Want Off The Air

    Blog ››› ››› DANIEL ANGSTER

    An editorial in the New Hampshire Union Leader criticizes Gov. Maggie Hassan’s (D) response to the opioid crisis, saying she has  focused more on Medicaid expansion than on the drug problem, and highlights a super PAC ad that also criticized Hassan for her failure to solve the epidemic. But Medicaid expansion would play a significant role in addressing the opioid crisis, and the ad touted by the Union Leader is in such poor taste that Hassan’s Senate opponent, Sen. Kelly Ayotte (R-NH), has asked the PAC to “take down their ad.”

    The June 8 editorial points to an ad produced by “the One Nation PAC affiliated with Senate Majority leader Mitch McConnell,” which claims that Hassan has dragged her feet in response to the state’s ongoing opioid abuse crisis. The editorial goes on to say that “Hassan has clearly made Medicaid expansion her top legislative priority over the past three years, not the opioid crisis.” From the Union Leader:

    The Democratic governor and U.S. Senate candidate isn’t happy about a new ad that points out her lack of leadership in addressing New Hampshire’s opioid crisis. The ad, produced by the One Nation PAC affiliated with Senate Majority leader Mitch McConnell, points out that Hassan’s veto of the state budget delayed an increase in funding for substance abuse treatment programs. It also criticizes Hassan’s do-nothing drug czar, and urges Hassan to work to pass the $1.5 million Granite Hammer program.

    Hassan and her allies freaked out about “out of state special interests.” But Hassan didn’t complain when Michael Bloomberg, Gabby Giffords or Harry Reid dumped millions in negative ads on Sen. Kelly Ayotte.

    And Hassan did veto the state budget, delaying the substance abuse program for three months. She did stand by a do-nothing drug czar for a year and a half before finally replacing him earlier this year.

    Hassan has clearly made Medicaid expansion her top legislative priority over the past three years, not the opioid crisis. She did nothing as House Democrats voted down the Granite Hammer program. If she’d cared as much as she claims, she would have worked to pass it.

    Soon after the ad was released, Ayotte tweeted that it should be taken down.

    The Union Leader’s claim that Hassan has attempted to prioritize Medicaid expansion -- which extends a state’s public health insurance program to those living at up to 138 percent of the federal poverty level -- over addressing the opioid crisis ignores just how important expansion is to addressing the crisis. The Center for Disease Control notes that those people most at risk for heroin addiction include “people without insurance or enrolled in Medicaid.”

    In addition, Medicaid expansion would play a crucial role in addressing the opioid crisis because access to health insurance means greater access to drug treatment. As Vox’s German Lopez explained, studies have shown that Medicaid paid for around a quarter of the combined “public and private spending for drug abuse treatment in 2014,” which “makes it the second biggest payer for drug abuse treatment spending after all local and state government programs” Lopez went on to note the two important ways that Medicaid expansion can help provide drug treatment:

    1) It gives people insurance they can use to pay for drug abuse treatment. According to a March report from the Department of Health and Human Services, about 1.9 million uninsured low-income people with mental illness or drug use disorders live in states without the Medicaid expansions. (The report did not elaborate just how many have a drug use disorder specifically, but it's likely in the hundreds of thousands.)

    2) It might encourage more treatment facilities to open up. The idea: If a state expands Medicaid, more treatment facilities may open up in those locations since they know they'll have paying customers. Saloner, who's working on a study related to this issue, said there's "some evidence" that insurance expansions can cause "shifts in the market for treatment."

    By fighting for the reauthorization of medicaid expansion in New Hampshire, Hassan has been advocating for one of the most effective tools in fighting the opioid crisis.

    The Union Leader’s editorial represents at least its second attempt to politicize the opioid crisis. In March, the board attacked Sen. Jeanne Shaheen (D-NH), saying the “politics were obvious” in Shaheen’s attempt to “score points” by adding an amendment to increase funding to a bill that provides states with grants aimed at addressing the opioid epidemic. The Union Leader said Shaheen’s amendment was an effort to provide “ammunition for Democrats to accuse Ayotte of not responding forcefully enough.” Yet, the editorial failed to note that Ayotte had co-sponsored and voted for the amendment.


  • As Trump Advisers Push Entitlement Cuts, NY Times Compares Trump To Sanders

    ››› ››› ALEX KAPLAN

    A New York Times article claimed that presumptive GOP presidential nominee Donald Trump’s pledge “to protect Social Security and Medicare” and to “leave entitlements untouched” indicates he’s taken a page from Democratic candidate Bernie Sanders’ campaign playbook. But The Times failed to note that Trump previously called Social Security a “Ponzi scheme” and that at least two of his advisers have advocated cutting or privatizing Social Security, Medicare, Medicaid, and disability benefits -- and have indicated as recently as this month that Trump would also be open to changing those programs.

  • Ahead Of SCOTUS Hearing, TX Media Highlight Negative Impacts Of "Dangerous" Anti-Choice Law

    ››› ››› TYLER CHERRY

    On March 2, the Supreme Court will hear oral arguments in Whole Woman's Health v. Hellerstedt, a "landmark case" that is challenging strict anti-choice Texas provisions, commonly known under its bill name HB 2, that medical groups say only serve to "reduce women's access to abortion." Many Texas media outlets are highlighting the negative impacts of restrictive abortion access, noting that Texas' anti-choice law is making abortions more "dangerous," "confusing," and "unattainable," specifically for rape victims, low-income women, Latina and immigrant women, and service women.

  • Fox's Eric Bolling Ignores Hyde Amendment, Demands A "Chinese Wall" Between Abortion And "Women's Services"

    Blog ››› ››› MEDIA MATTERS STAFF

    Fox's Eric Bolling reacted to an argument from The Five co-host Dana Perino that "defunding Planned Parenthood" is problematic by suggesting that the way to solve the problem is to "separate" abortion services from "woman's services." But under the federal 1977 "Hyde Amendment," such a suggestion has been the law for almost 40 years.

    Since 1977, the Hyde Amendment has stipulated that federal funds cannot be used to cover the cost of abortion, with the exception of abortions in the case of rape, incest and to protect a woman's life. Federal Medicaid funds are reimbursements for medical services provided to Medicaid patients, such as STD screenings, birth control, and cancer screenings. Although states may use state funds for Medicaid to cover the cost of abortions, 32 states and the District of Columbia follow the federal standards. Title X, another major source of federal funding for family planning services at Planned Parenthood, is similarly prohibited from covering abortions.

    During the December 22 edition of Fox News' The Five, however, co-host Bolling claimed the Republicans "haven't figured out" how to "defund the abortion part of Planned Parenthood," and suggested setting up a "Chinese wall."

    DANA PERINO: A couple of things though, Planned Parenthood, they bring up the defunding Planned Parenthood. Here's the box that Republicans are in. So when you're in a competitive primary, and you have to run to try to win that, you have to deal with what your party wants, okay? That party might want repeal. But Planned Parenthood defunding, that actually polls so negatively for the GOP. It has about, funding Planned Parenthood has about a 65 to 70% approval rate so that makes it very difficult then when you switch to go to a general election. Where I think Hillary Clinton is more vulnerable than they will admit is on Obamacare. If you look at Kentucky, for example, where we had a special election in 2014, the Republican candidate was not expected to win, he was down by about a touchdown, he won by about a touchdown. And this has the Democrats worried, because that and all the exit polls was mostly about Obamacare.


    GREG GUTFELD: Eric, Why can't they discuss the topic of national security?

    ERIC BOLLING: It's a lose for them. She just highlighted all the things that they think they're winning. Dana points out Planned Parenthood. There is a way to defund the abortion part of Planned Parenthood. But the Republicans haven't figured out how to do that. Just separate the two. There's women's services and there's abortion. You want to fund women's services, knock yourself out. Just don't meld them. It's so easy, it's a Chinese wall.


    Conservative Media Pretend Federal Taxpayers Foot The Bill For Abortions


    Fox Anchor Refuses To Accept That Planned Parenthood Doesn't Use Taxpayer Money On Abortions

    Fox News Pushes Impossible Claim That Community Clinics Could Fill Gap If Planned Parenthood Loses Funding

    Fox Hosts Have No Idea What Planned Parenthood Does Or How Obamacare Works

  • Major State Newspapers Failed To Cover The Higher Cost Burden Assumed By States That Opted Out Of Expanding Medicaid


    An October 15 Kaiser Family Foundation study highlighted the increased health care cost burden for states that did not expand Medicaid under the Affordable Care Act (ACA). Yet, in the three non-expansion states with the highest number of individuals who would benefit from expansion, the highest-circulating state newspapers failed to mention the increased state cost associated with the lack of expansion.

  • Austin American Statesman Editorial: Texas Is Putting "Politics Before Public Health" In Planned Parenthood "Witch Hunt"

    Blog ››› ››› RACHEL LARRIS

    The editorial board of the Austin American Statesman has called the decision by Texas "lawmakers and state officials" to investigate Planned Parenthood for Medicaid fraud part of a "witch hunt" that won't stop until the health care provider "is completely dismantled in Texas."

    An October 28 editorial by the Austin American Statesman discussed the state's plan to stop reimbursing Planned Parenthood with state Medicaid funds for treating low-income patients and its issuing of subpoenas to three clinics for detailed patient records as part of an investigation into alleged Medicaid fraud. The editorial board correctly pointed out that the state "has not yet produced any evidence to support its allegation that laws or policies were broken aside from the heavily edited videos taped in secret and released by an anti-abortion group" -- videos which have been thoroughly debunked by independent experts but are still being characterized as factual by right-wing media. The editorial added that "the timing of the investigation" suggests that the state is attempting to "validate its decision with a retroactive investigation." And it warned that "the apparent willingness of Texas leaders to put politics before public health bodes ill for them and for the state.

    Texas is gearing up for a full-fledged witch hunt.

    The target is women's health provider Planned Parenthood, and it is clear that lawmakers and state officials will not stop until the 94-year-old nonprofit is completely dismantled in Texas.

    Last week ended with Planned Parenthood being put on notice that the state intended to strip the nonprofit of its ability to receive Medicaid reimbursement for health services, alleging that Planned Parenthood had "committed and condoned numerous acts of misconduct captured on video."

    Interestingly, the state has not yet produced any evidence to support its allegation that laws or policies were broken aside from the heavily edited videos taped in secret and released by an anti-abortion group called the Center for Medical Progress. The controversial fetal tissue program that has dominated the national headlines doesn't even exist in Texas.


    The timing of the investigation certainly gives the impression that the state is trying to validate its decision with a retroactive investigation.


    Ultimately those who will suffer are the low-income Texas families who rely on Planned Parenthood for contraception and medical care. They deserve the same access to care and the same ability to choose their own medical providers that the rest of us have come to expect.

    When it comes to women's health care, Republican leaders seem determined to score political points at the expense of the state's public health and individual freedom of choice that extends far beyond the ability to decide whether to have an abortion.


    We fully understand the politics of abortion. However, the apparent willingness of Texas leaders to put politics before public health bodes ill for them and for the state.

  • NPR Exposes The Lies In Fox's Disinformation Campaign About State Medicaid Expansion

    Blog ››› ››› MEDIA MATTERS STAFF

    An article on effectively debunked Fox News' fearmongering about states that chose to accept federal funds to expand Medicaid eligibility, pointing out that "states whose governors, most Republicans who opposed the Affordable Care Act, chose not to accept federal funds to extend Medicaid to more people ... saw their costs to provide healthcare to the poor rise twice as fast as states that extended benefits to more low-income residents."

    The October 15 article by's Alison Kodjak cited a Kaiser Family Foundation survey of Medicaid directors that found that states "that didn't broaden coverage saw their Medicaid costs rise 6.9 percent in the fiscal year that ended Sept 30," while states that expanded coverage "saw their costs rise only 3.4 percent." Kodjak noted that "that modest increase in Medicaid spending in the expansion states came even as the rate of Medicaid participation rose 18 percent, three times as much as the states sitting out."

    After the Supreme Court gave states the ability in 2012 to choose to reject Medicaid expansion, Fox News repeatedly misled its viewers by claiming that the cost of expanding Medicaid rolls was unaffordable for states, who should reject federal funds to do so. In the aftermath of Fox's disinformation campaign, 5.7 million uninsured Americans were prevented from getting health insurance under the Affordable Care Act's Medicaid expansion in states where governors embraced that claim. Fox News' subsequently blamed this gap in coverage on the Affordable Care Act, instead of on Republican governors who turned down federal money that would have allowed them to add more people to the insurance rolls. From the article:

    The 22 states that didn't expand Medicaid eligibility as part of Obamacare last year saw their costs to provide health care to the poor rise twice as fast as states that extended benefits to more low-income residents.

    It's a counterintuitive twist for those states whose governors, most Republicans who opposed the Affordable Care Act, chose not to accept federal funds to extend Medicaid to more people.

    A Kaiser Family Foundation survey of Medicaid directors in all 50 states and Washington, D.C., showed that those that didn't broaden coverage saw their Medicaid costs rise 6.9 percent in the fiscal year that ended Sept. 30. The 29 states that took President Obama up on his offer to foot the bill for expanding Medicaid saw their costs rise only 3.4 percent.

    That modest increase in Medicaid spending in the expansion states came even as the rate of Medicaid participation rose 18 percent, three times as much as the states sitting out.


    There have been stark differences between states that take up the expansion and those that don't.

    Texas, for example, hasn't expanded eligibility and its rolls have increased by about 192,000 people in the last two years, or just 4.3 percent. Federal reimbursements to the state fell last year from 58.05 percent to 57.13, according to the Kaiser study.

    California, by contrast, was among the first states to sign on to the expansion. Enrollment in Medi-Cal, the state's name for Medicaid, grew by 30 percent in the first year. All told, 3.4 million Californians were added to the Medi-Cal rolls between Sept. 2013 and July 2015.

  • Media Run With Discredited Nativist Group's Research To Claim More Than Half Of Immigrant Households Receive "Welfare"

    More Questionable Research From The SPLC-Labeled Nativist Group, The Center For Immigration Studies


    Numerous conservative media outlets are parroting the misleading conclusions of a September 2015 report by an anti-immigrant nativist group, the Center for Immigration Studies (CIS), which claims that "immigrant households use welfare at significantly higher rates than native households." Like previous flawed CIS studies, these findings have been called into question by immigration experts for failing to account for the economic hardship of some immigrant families, lumping American-born beneficiaries into "immigrant household" categorizations, and conflating numerous anti-poverty programs with so-called "welfare."

  • Fox's Attempt To Smear Planned Parenthood With "Taxpayer Calculator" Doesn't Add Up

    Blog ››› ››› CRAIG HARRINGTON

    Caution: Images On Fox News May Be More Misleading Than They Appear

    Fox News' dishonest campaign against Planned Parenthood took a new turn when the network promoted its own deeply misleading "Taxpayer Calculator" purporting to show how much an average American taxpayer has contributed to the health care provider over the past decade.

    On the July 27 editions of Fox News' America's Newsroom and Happening Now, correspondent Shannon Bream continued her network's smear campaign against Planned Parenthood Federation of America centered around a deceptively-edited video alleging to show PPFA employees negotiating the sale of "fetal body parts for medical research." Bream promoted the efforts of Sen. Rand Paul (R-KY) and Rep. Diane Black (R-TN) to strip federal funding for the organization before referring viewers to a so-called "Taxpayer Calculator" created by the network to show people how much they have contributed to Planned Parenthood over the past decade. From America's Newsroom:

    BREAM: Over the past 10 years, it's estimated Planned Parenthood has received more than $4 million [sic] in federal and state government funding. Here's a look at what you, the taxpayer, have contributed based on your income level. Now, if you want a more specific estimate on just how much you've given to Planned Parenthood, head to and click on "Taxpayer Calculator." Martha.

    MACCALLUM: That's going to get a lot of people's attention.

    BREAM: It will.

    First, and perhaps most egregiously, the on-screen graphic Fox shows during both segments falsely claims that Planned Parenthood received $4.3 billion-worth of federal funding "over 10 years." According to the "Taxpayer Calculator" Bream referenced during the segment, Fox News does not actually know how much public support comes from either federal or state sources (emphasis added):

    Planned Parenthood and its affiliates have received $4.3 billion in government funding over the last ten years, according to the group's annual reports. Their government funding comes from both federal and state governments. We do not know exactly how much of Planned Parenthood's funding comes from the federal government.

    According to Planned Parenthood's most recent annual report, the organization received $528.4 million from "Government Health Services Grants & Reimbursements," which amounted to just over 46 percent of its operational revenue as of June 30, 2014. Some of this funding came in the form of federal Medicaid reimbursements for health care services for low-income Americans, while other funds came from various local, state, and federal grants -- the Hyde Amendment "excludes abortion from the comprehensive health care services provided to low-income people by the federal government through Medicaid."

    After incorrectly assuming that all public money received by Planned Parenthood comes from the federal government, Fox News staff then based their taxpayer contribution calculations on the proportion of federal tax revenue derived from different income tax brackets. Federal income tax rates are higher than state and local income tax rates. In fact, seven states levy no income taxes at all while two others tax only capital gains and dividends, not traditional wages. Fox's sloppily constructed "average taxpayer share" does not reflect reality -- it's simply the highest estimate the network's research team could produce.

    Finally, Fox's investigation of Planned Parenthood's revenue and the American taxpayer's contribution to that revenue provides no useful context for the viewer. In 2014, the federal government spent nearly 900 times more than Planned Parenthood collected from all government sources in 10 years; the $4.3 billion price tag Fox highlighted represents a miniscule portion of total government spending over the same period. Likewise, the 10-year burden shouldered by Fox's "average taxpayer" represents a tiny fraction of their total income over that period. According to Fox News, a taxpayer with earnings in excess of $2.5 million over a decade would contribute only about $40 annually. Meanwhile, the average taxpayer, with a median household income of roughly $52,000 per year, would contribute only about $1.50 per year to Planned Parenthood, according to Fox's own calculations.

    The deceptive "Taxpayer Calculator" is a continuation of Fox News' long campaign of deceit against Planned Parenthood, despite the fact that the overwhelming majority of the work performed by the organization (97 percent) is not related to abortion services. Fox has demonstrated on many occasions that it has no clue what Planned Parenthood does or the vital services it provides for millions of men and women every year; including cancer screening and preventative treatment, contraceptive services, family planning, STI/STD screening, and assorted other women's health services.

    For more examples of right-wing media promoting anti-Planned Parenthood smears, see: here, here, here, and here.

  • Fox's Hannity Helps Kasich Walk Back "War On The Poor" Comments

    Blog ››› ››› CRAIG HARRINGTON

    Kasich Walks Back Advocacy For The Poor, Proposes ACA Repeal

    Fox host Sean Hannity allowed Republican presidential candidate and Ohio Gov. John Kasich to walk back comments he made during a 2013 New York Times interview in which Kasich expressed his concern "about the fact there seems to be a war on the poor" emanating from his own party.

    On the July 21 edition of Fox News' Hannity, host Sean Hannity interviewed newly-declared Republican presidential candidate John Kasich at Ohio State University. Kasich used the softball interview to rehabilitate his conservative credentials while quietly disavowing his previous comments about the draconian agenda of GOP policymakers on Capitol Hill. When asked whether or not he truly believed "Republicans are waging war" on the poor, Kasich deflected the question by saying, "I don't know where that came from." Both then impugned the credibility of The New York Times while Kasich outlined the ways he plans to help poor and struggling Americans as president, including repealing the Affordable Care Act (ACA):

    HANNITY: Let me ask you, in the lead up to this, a lot of articles were written -- "Is John Kasich conservative enough?" Now, you were quoted in The New York Times as saying about your party, the Republican Party, that it's waging "a war on the poor." When you accepted Medicaid expansion, you went out there and you talked about St. Peter at the Pearly Gates, he's not gonna ask me if I decreased the size of government but whether I helped the poor. Do you really believe Republicans are waging war on--

    KASICH: No, no, but look, I don't know where that came from, but here's what I will tell you--

    HANNITY: The New York Times.

    KASICH: Yeah but, I-- Okay, well then it has to be true, okay? But here's the thing--

    HANNITY: How dare I quote a New York paper.

    In fact, during an interview with a New York Times reporter following his October 22, 2013 decision to accept Medicaid expansion in the state of Ohio under the ACA , Kasich expressed his concern that "there seems to be a war on the poor" coming from Republican ranks, including the stigma that low-income Americans are "shiftless and lazy":

    COLUMBUS, Ohio -- In his grand Statehouse office beneath a bust of Lincoln, Gov. John R. Kasich let loose on fellow Republicans in Washington.

    "I'm concerned about the fact there seems to be a war on the poor," he said, sitting at the head of a burnished table as members of his cabinet lingered after a meeting. "That if you're poor, somehow you're shiftless and lazy."


    But few have gone further than Mr. Kasich in critiquing his party's views on poverty programs, and last week he circumvented his own Republican legislature and its Tea Party wing by using a little-known state board to expand Medicaid to 275,000 poor Ohioans under President Obama's health care law.

    Kasich's remarks were widely reported at the time by numerous reputable news outlets, including New York Times columnist and Nobel Prize-winning economist Paul Krugman. A November 1, 2013 column by Salon editor-at-large Joan Walsh pointed out the hypocrisy of Kasich lamenting his party's "war on the poor" while he simultaneously pushed an initiative to cut food assistance for up to 130,000 Ohio residents. Kasich's supposed willingness to take on the GOP's backwards anti-poverty agenda is often pointed to as an indication of his seriousness as a president candidate.

    Fox's decision to let Kasich disavow his "war on the poor" comment is interesting, particularly in light of recent criticism from Heritage Foundation economist and Fox News contributor Stephen Moore that the governor's stance on poverty is "not an answer that conservatives are very persuaded by." Moore's intuition may be right. Kasich is a distant 11th -place contender in the Real Clear Politics polling average of the 16 declared Republican candidates. Kasich is also far behind in the crucial Fox News Primary and is in desperate need of positive exposure on the network.

  • Tampa TV Report On Low Income Medical Funding Fails To Mention Republican Refusal To Expand Medicaid

    Blog ››› ››› DANIEL ANGSTER

    Tampa Bay Fox television station WTVT left out the fact that Florida Republican Gov. Rick Scott and the Republican-led legislature refused to expand Medicaid under the Affordable Care Act (ACA) in its story about an ailing young boy whose family might have to struggle to pay for health care as a result of reductions in federal Low-Income Pool (LIP) funding, even though experts say that expanded Medicaid would cover many such people at risk.

    In a July 13 report, WTVT - which is owned and operated by parent company 21st Century Fox -- profiled a seriously ill young boy whose medical care could be jeopardized by reductions in federal LIP funding - money provided by state and federal resources "to support health care providers that provide uncompensated care to Florida residents who are uninsured or underinsured." While the report noted that federal matching funds for LIP would be phased out in the near future, it made no mention of the fact that expanding Medicaid in Florida -- which the state legislature and Gov. Scott has rejected -- would protect many families and individuals affected by LIP funding reductions:

    Experts agree that expanding Medicaid could solve many of the problems created by reduced LIP funding. As the Center on Budget and Policy Priorities explained, reductions in LIP funding are a result of the ACA's "creation of an explicit pathway for Medicaid coverage for adults with incomes below 138 percent of the poverty line, which changed CMS's (Centers for Medicare and Medicaid Services) criteria for approving state plans to fund uncompensated care." As Politifact Florida reported, the two programs are not directly connected, but Gov. Scott's acceptance of the Medicaid expansion funds could mean continued health care coverage for many who currently benefit from LIP funding (emphasis added):

    The LIP started in 2005 and was renewed until 2013. But when it came time to negotiate another extension for 2014 and beyond, Florida upped the funding request to a whopping $4.5 billion to expand the program. This was after the state refused some $51 billion in Medicaid expansion money over 10 years under the Affordable Care Act, to expand that program to anyone making up to about 133 percent of the poverty level, as the Obama administration wanted. The U.S. Supreme Court in 2012 ruled states had a choice whether to take the money or not.


    In many ways, LIP isn't associated with Medicaid expansion, [Joan] Alker said, given that LIP started while Jeb Bush was governor and George W. Bush was president. But an expanded Medicaid would cover many of those patients, or use preventive care to keep them out of the hospital to begin with, she said.

    Washington and Lee University professor Timothy Jost added that money for the Medicaid expansion was guaranteed by law in the Affordable Care Act, something not true about the program that created LIP, which is doled out as discretionary spending. (Jost supports the health care law.)

    Of course, it's technically possible the federal government could change the law to do away with whatever program they like, including Medicaid. But that would require both houses of Congress and the president to agree on the terms, something "that isn't likely to happen anytime soon," Jost said.

    Now Florida faces a tough set of choices: Find a new source of LIP funding, end the program altogether or negotiate with CMS to either revamp the program or get another extension, possibly for as short as one month. Florida also could decide to cover those patients by expanding Medicaid.