The thing I don’t get with States saying they’ll refuse the Medicaid expansion is how come they’re in the current Medicaid program at all then. Under current Medicaid and CHIP the federal gov’t share of costs is like 50 to 65%, while under the big ACA medicaid expansion, the fed gov’t pays 100% until 2016, decreasing to 90% by 2020, and it stays at 90% from then on.

If 90% federal reimbursement isn’t enough to make the huge decrease in uninsured and all the related State health benefits that would come with that worth it, how are these same states okay with remaining in the existing Medicaid or CHIP programs?