Since the passage of the Affordable Care Act, or ACA, governors and state legislators in Florida, Texas, Tennessee, and Kansas have been acutely aware of the need to expand Medicaid coverage or risk leaving their citizens in the coverage gap, losing state jobs, and hurting local economies. These four states rely largely on federal funding from the low-income pool, or LIP, to support hospitals and safety net providers who care for the uninsured. The Medicaid expansion included in the ACA is intended to replace this system by directly offering coverage to low-income Americans, but these states rejected the expansion for political reasons and instead are clinging to expiring LIP funding. Florida Gov. Rick Scott (R) has gone so far as to sue the federal government in lieu of accepting the Medicaid expansion—despite the fact that the federal government has no legal obligation to renew LIP funding and warned these states in 2014 that it would expire one year later. Texas and Kansas have each filed amicus briefs in support of Florida in the lawsuit. This blatant political gambit only serves the ambitions of the likes of Gov. Scott, while leaving millions of people without health coverage.
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