Medicaid expansion has been touted by proponents as a no-brainer because it will save states money. However, this appears to be true only for states with already bloated Medicaid programs. For the majority of states, expanding Medicaid under the Affordable Care Act (ACA) will cost money, says Drew Gonshorowski of the Heritage Foundation.

Forty of the 50 states are projected to see increases in costs due to Medicaid expansion. Only New York, Connecticut, Delaware, Hawaii, Iowa, Maine, Maryland, Massachusetts, Vermont and Wisconsin stand to save money. For these the states, restructuring their existing programs will allow them to transfer substantial cost to the federal ledger.

The estimates of savings for these states assume that the costs of uncompensated care will decrease, which has not always been the case in other states following expansions of Medicaid. The estimates also assume that state legislators will reduce state supplemental payments to providers, which is an assumption that is not guaranteed.

Expanding Medicaid represents a massive increase in federal and state spending for most states. For the first three years that the federal government will match 100 percent of state expenses, most states may see modest savings. As soon as the federal match rate begins to lower, states will experience rising costs that will offset any projected savings.

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