A new study by the Urban Institute examines projected state-by-state spending burdens under the planned Medicaid expansion in 2014 and shows a wide variation in who pays what.
The findings also demonstrate which states have the largest populations likely to benefit from participating in Medicaid expansion.
Western and southern states tend to place a larger burden of spending on those with low incomes compared to states on the East and West Coasts, according to the study. For example, Virginia, North Dakota, Utah and Louisiana have residents with incomes below 138 percent of the Federal Poverty Level who devote more than 20 percent of their income to medical spending.
By comparison, low-income residents of California, New York, the District of Columbia and Delaware spend well below 15 percent of their income for medical needs. However, there are some eastern and western states that defy the trends, such as Kansas (13.9 percent), Tennessee (14.2 percent) and Maryland (23.6 percent).
Shifting large healthcare spending burdens to the poor tends to financially affect hospitals, which often have few recourses in collecting from low-income uninsured or underinsured patients.
The Urban Institute study concluded that the expansion of Medicaid would "decrease the risk of medical spending and high burden levels of low-income individuals compared with everyone else."
However, many states with high burdens of spending, such as Louisiana, Arkansas and Mississippi, have vowed not to increase their Medicaid rolls under the Affordable Care Act.
In Missouri, which has a Democratic governor, but a GOP-dominated Legislature, BJC Healthcare CEO Steven Lipstein has been advocating for expanding Medicaid, according to the St. Louis Post-Dispatch. "Expand Medicaid and hospitals won't have to charge private customers and their insurers, including employer-sponsored health plans, quite as much to cover the cost of uncompensated care," Lipstein told the newspaper.
In Missouri, the poor pay 15.9 percent of their income on medical care.