This week, in a historic vote, the Wyoming House of Representatives voted to pass Medicaid expansion for the first time in a decade-long fight. Policymakers in Alabama are having serious conversations about what an Alabama-specific expansion plan will look like. Local news outlets are publishing editorials like this one in Kansas and this one in North Carolina, declaring that it is time to expand Medicaid. National reporters are picking up on state-level conversations and writing important stories, like this one, about Medicaid expansion.  

When the American Rescue Plan passed, it included generous incentives for the 12 states who have not yet expanded Medicaid to adults with low-incomes under the Affordable Care Act to do so. The new federal incentives have the potential to bring billions of dollars to states that finally expand Medicaid, funding that will cover the entire cost of expansion and then some, so that states can fill budget holes left by the COVID-19 health and economic crisis. The federal funding is substantial and is changing the conversation in states that have continually rebuffed expansion. And it’s far past time. 

Medicaid expansion is an urgent issue of health and racial justice. If all 12 of the remaining states expand, 4 million more Americans will be eligible for health coverage, 60 percent of whom are people of color. Those living in the coverage gap – making too much to be eligible for Medicaid but too little for a Marketplace plan – are disproportionately women, immigrants and Black and brown people due to unfair and discriminatory barriers to health and economic security. Eight of the 12 non-expansion states are in the South.  

There are hundreds of research studies that show expanding Medicaid has both health and economic benefits. In Medicaid expansion states, the percentage of low-income adults with medical debt fell by almost half. The gap in uninsured rates between white and Black adults shrunk by 51 percent. Medicaid expansion improved Black cancer patients’ receipt of timely treatment. It led to greater reductions in low birthweight and pre-term birth in Black babies and fewer Black women dying during childbirth. 

The inequity has long provoked outrage, rightfully, and the new federal incentives may be what it takes to move those states on a path toward health justice. 

Four million people have been waiting over 10 years for health coverage. In that time, non-expansion states have not come up with any reasonable solution to the problems that Medicaid expansion will solve. The new federal funding warrants a fresh look at expansion from past opponents. And, in some states, like Wyoming, where, according to the Editorial Board of the Casper Star Tribune, the Senate should give Medicaid expansion a fair hearing this week, it may be the thing that finally gets Medicaid expansion across the finish line. It certainly should be.