Should States Roll The Dice On Medicaid?

In a recent study in Health Affairs, Carter C. Price and Christine Eibner calculate the impact of the states opting out of the Medicaid expansion:

With fourteen states opting out, we estimate that 3.6 million fewer people would be insured, federal transfer payments to those states could fall by $8.4 billion, and state spending on uncompensated care could increase by $1 billion in 2016, compared to what would be expected if all states participated in the expansion. These effects were only partially mitigated by alternative options we considered. We conclude that in terms of coverage, cost, and federal payments, states would do best to expand Medicaid.

Tyler Cowen counters that their analysis ignores the “real chance” of Republican control of the House, Senate, and Presidency after the next election:

I often interpret the Republicans as operating in a “they don’t really mean what they say” mode, but on Medicaid I think they basically do mean it and we already can see some of the demonstrated preference evidence. Furthermore a new Republican President would face very real pressure to “repeal Obamacare,” yet we all know that the “three-legged stool” centered around the mandate is hard to undo selectively. That ups the chance Medicaid will be the target and much of the rest will be relabeled (“repealed,” in the press release) but in some manner kept in place in its essentials. …

[I]f someone wants to argue that, given these considerations, Medicaid expansion still makes financial sense for a state, fine, I would be keen to read such an analysis.  But that is not what I am seeing.  The Price and Eibner piece doesn’t analyze these considerations or even bring up most of them.  Governors are not stupid, or their chiefs of staff are not stupid, and many governors are far less ideological than they let on.  They are politicians.