Major newspapers in Pennsylvania, Oklahoma, and Nevada have urged their governors to reject expansion of Medicaid -- the shared state-federal program that provides health care coverage to low income Americans -- under the Affordable Care Act, citing high costs that they claim would add to the states' financial burdens. In fact, a new report by the Kaiser Family Foundation finds that the Medicaid expansion would substantially reduce the number of uninsured at little cost to their state budgets.

As governors continue to decide whether to implement key aspects of the Affordable Care Act, the editorial boards of the Pittsburgh Tribune-Review and the Las Vegas Review-Journal urged the rejection of Medicaid expansion, while the editorial board of The Oklahoman applauded the recent decision by Republican Gov. Mary Fallin to reject the funding.

From the Pittsburgh Tribune-Review:

As stipulated under the Patient Protection and Affordable Care Act, Medicaid eligibility will expand to an additional 800,000 Pennsylvanians -- in effect, placing a quarter of the state's residents on government insurance, according to the Commonwealth Foundation. Never mind that Medicaid currently consumes 30 percent of the state's operating budget.

[...]

Once fully realized, ObamaCare will have all the appeal of a perpetual flu.

From the Las Vegas-Review Journal:

The accompanying Medicaid expansion, meanwhile, would throw millions of additional Americans into a system that's already bankrupting state governments and increasing costs in the private market. Geoffrey Lawrence of the Nevada Policy Research Institute, noting last week that Gov. Sandoval is pondering whether to expand Medicaid eligibility in Nevada, said any Medicaid expansion would mean reduced access to care for those currently enrolled.

[...]

President Obama won re-election this month, but the states hold the future of ObamaCare in their hands. Knowing the harm the law would do to our citizens, the economy, and the quality of American health care, Gov. Sandoval should join with many of his colleagues and decline to become the enabler of a vastly expensive, European-style medical rationing system that poll after poll has shown most Americans do not want.

From The Oklahoman:

Oklahoma has joined a growing list of states that won't expand Medicaid or implement state-run health exchanges, two key components of Obamacare. Predictably, the political left argues Republicans are being obstructionist. But why would state Republicans rush to implement a bad law to benefit a president who's made clear he would never do the same if the tables were turned?

As of June 2011, Medicaid programs in all 50 states and the District of Columbia provided health care coverage to 52.6 million people. However, as the economy has improved, the rate of growth of enrollment in the program has slowed down. With the passage of the Affordable Care Act, the federal government wants to expand the program in an effort to decrease the number of uninsured by providing coverage to those with an income below 133 percent of the federal poverty level. Previously, qualification for the program varied depending on factors such as age or employment status. Despite the claims from these editorial boards, the Affordable Care Act's Medicaid expansion provision will in fact achieve its goal, at only a slightly higher cost than what those states currently pay for Medicaid.

A recent study published by the Kaiser Family Foundation found that if all states expanded Medicaid it could lead to health care coverage for an additional 21.3 million people nationally with a total cost of around $1 trillion. Yet, the combined costs to states would only be approximately $76 billion as the federal government will cover the other $952 billion.

Specifically, Pennsylvania, Nevada, and Oklahoma would see significant increases in the number of people insured for only small changes to their current spending.

In Pennsylvania, if all states expanded Medicaid, the state would see a 52 percent reduction in uninsured citizens, while spending 1.4 percent more on Medicaid than current expenditures when accounting for the savings in uncompensated care. While Pennsylvania's expansion costs are higher than some other states, healthcare professionals note that this is because Pennsylvania currently has one of the more draconian Medicaid systems in the country. From WHYY in Pennsylvania:

New Jersey is on the opposite end of the spectrum, with projected costs of $1.2 billion with an expansion. And Pennsylvania? Almost $2 billion over 10 years, even after accounting for savings.

“Pennsylvania has not expanded to adults whereas other states have,” said Ann Bacharach with the Pennsylvania Health Law Project.

“If you're a single, childless adult, there is not much that the state can offer in terms of coverage,” Bacharach said.

So the new enrollees covered by an expansion would add costs, but the federal contribution would not provide the same savings in Pennsylvania as it will in Delaware.

Meanwhile, Nevada would see a 44.8 percent reduction in uninsured citizens for only 2.6 percent more in Medicaid spending if all states expanded Medicaid coverage. As Media Matters has previously noted, the Review-Journal's editorial board has attacked the Medicaid provision of the Affordable Care Act while neglecting to note any of the benefits expanding Medicaid would have on their state. 

Lastly, Oklahoma would see a 54.4 percent reduction in uninsured for only 1.9 percent more in Medicaid spending if all states expanded Medicaid coverage. From Tulsa World:

[David Blatt, director of the Oklahoma Policy Institute] said the governor's calculations also leave out savings to the state in areas such as health, mental health and corrections that are currently outside the Medicaid system but could be included with expansion. Savings to those agencies has been estimated at more than $49.4 million a year.

Also missing from the calculation would be tax revenue increases the state would see as a result of the Affordable Care Act, he said.

For example, the state has a small tax on insurance premiums. If thousands of Oklahomans begin purchasing insurance through a federal health insurance exchange, that tax revenue goes up, he said.

If every state adopted the Medicaid expansion provision they would receive $9 in federal money for every $1 they spend to expand the program.  As John Holahan, head of the Urban Institute's Health Policy Research Center and the study's author, said, “It's hard to conclude anything other than this is pretty attractive and should be pretty hard for states to walk away from.” Unfortunately, the editorial boards of the Tribune-Review, Review-Journal, and The Oklahoman failed to provide that perspective and explain the overall benefit of Medicaid expansion to their readers.