Medicaid Expansion

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You mentioned a few minutes ago those who are eligible for Medicaid. Obviously, as you know, there are millions of people living in states that have chosen not to expand Medicaid. We heard from folks like Emily in Alaska, Sarah from Texas, and Pat from Georgia. And Pat says that she hardly makes enough money to pay her bills. She asked, "Is it possible for me to get coverage or am I one of the forgotten?" And Stephen from North Carolina asked, a little bit more pointedly, "Can't you reinstate the Medicaid expansion by executive order?"

This is a source of great frustration for me, because what the law does is it says to states, expand Medicaid for the folks that just wrote you those letters and the federal government will give you a 100% match, meaning the state won't have to put out any outlays and your citizens will be insured. And for political reasons, a number of the states have chosen not to take us up on that. And the Supreme Court said we could not condition other programs, like existing Medicaid programs, on them accepting it.

So we don't have the ability, at the federal level, to pressure these states to do what they should be doing. Hopefully, citizens in those states, as they look at neighboring states that are expanding Medicaid, will say, well, why would you, Mr. Governor or members of the state legislature, choose deliberately to leave people in our states uninsured, particularly when it doesn't cost the state any money?

So in the interim, the best we can do for those unfortunate folks who are caught in this situation is to say to them that they will not be subject to a penalty for not getting health insurance. It's not their fault that the state is not doing what it should do. But in the meantime, that means that they're still relying on emergency room care or a free clinic or just foregoing care, which is bad policy, it's bad for those families. And I hope that everybody who's watching, as time goes on, is continuing to put pressure on those states to do the right thing.

We've seen some states where Republican governors have said, you know what, it's the right thing to do, even though I may not agree with the president. And they've gone ahead and done it, and people have benefited from it. And I hope that that ends up being true in all 50 states. Right now, it's not true in a number of states, including some big ones like Texas, where a lot of people are being impacted.