These 10 states have not expanded Medicaid

North Carolina state lawmakers on Thursday reached an agreement to expand Medicaid, ending a decade-long battle in the state over whether to accept federal funding to expand the program, which provides health insurance to adults on low incomes.

North Carolina’s agreement to mark the 13th anniversary of the Obama-era Affordable Care Act, which offered states Medicaid expansion, removes another state from the list of Medicaid expansion objectors as an overwhelming majority of states expressed support accepted by the federal government.

But even as Congressional Democrats try to get state legislators to accept federal funding to expand Medicaid, a dwindling number of states continue to turn up their noses at the offer. Here are the states that haven’t yet adopted the Medicaid Amendment to the Affordable Care Act.

Ten states have yet to adopt the Medicaid expansion

With the North Carolina legislature’s announcement of an agreement to expand Medicaid, that leaves 10 states that have not accepted the expansion, all of which have either a Republican-controlled legislature or a Republican governor.

Wyoming, Kansas, Texas, Wisconsin, Tennessee, Mississippi, Alabama, Georgia, South Carolina and Florida have yet to adopt the expansion of Medicaid, leaving over 2.1 million people in the “care gap” — meaning falling into income levels fall that doing so would make them eligible for Medicaid but cannot access it because their state has not accepted it, according to the Center on Budget and Policy Priorities.

South Dakota has accepted the expansion but has yet to implement it, which is planned for later this year.

Why haven’t these states adopted the Medicaid expansion?

The Medicaid expansion, introduced in former President Obama’s landmark Affordable Care Act, has long been the subject of partisan debate.

The law has been championed by Obama and Democrats as a step in the right direction toward universal health coverage and lowering health care costs. However, Republicans argue that this is the federal government’s overstepping into the open market, increasing costs and threatening coverage quality.

Republican lawmakers at the state level have stuck closely to the argument that Medicaid expansion is federal overreaching, criticizing the level of government spending rather than letting private insurers navigate the market themselves.

But Democrats have kept their foot on the pedal to try to get Republican states to accept the expansion, providing financial incentives for the change. As part of the original Affordable Care Act expansion, the federal government committed to a 90 percent match rate of funds used to expand the program. The 2021 American Rescue Plan further incentivized states, offering another 5 percent match of federal funding for two years if the remaining holdout states accept the expansion.