Medicaid Expansion Push Sparks Budget Fears in 10 Holdout States
A push is growing for the last 10 states to expand Medicaid to able-bodied adults. But critics argue the move would strain budgets and divert help from the most vulnerable. Over the past decade, expansion has led to higher costs and unexpected challenges in states that adopted it.
Currently, Alabama, Florida, Georgia, Kansas, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming still resist expansion. Meanwhile, data shows existing programmes have struggled with fraud, long waiting lists, and ballooning expenses.
Between 2016 and 2026, South Dakota, North Carolina, and Oklahoma expanded Medicaid under the Affordable Care Act. Yet in every state that tried it, the programme fell short of promises. West Virginia, for example, now has over 35% of its population on Medicaid—more than double early projections.
Costs have also surged beyond expectations. Medicaid already consumes around 30% of state budgets, with some states nearing 40%. California, Illinois, and Louisiana saw far higher enrolment and expenses than forecast. California even improperly claimed millions in federal funds for non-emergency benefits given to illegal immigrants. Fraud has added to the strain. Nearly three million people were caught double-dipping benefits across states or enrolling in both Medicaid and ObamaCare. At the same time, over 700,000 patients remain on waiting lists nationwide. Tens of thousands have died while able-bodied adults received coverage instead. The proposed One, Big, Beautiful Bill would raise costs and requirements for states that already expanded. Critics say now is the worst time to push for further growth, as resources shift away from the elderly and disabled children—the very groups Medicaid was meant to protect.
The debate over Medicaid expansion continues as the remaining states face pressure to join. But the data from the past decade shows rising costs, fraud, and long waiting lists for the most vulnerable. With budgets stretched thin, lawmakers must weigh whether expansion would do more harm than good.
