There are thirteen states left who have resisted federal pressure to expand their Medicaid programs. Matt Dean, senior fellow on health care at The Heartland Institute, has been testifying before state legislatures in those states explaining why these states should resist the federal financial bait. In some cases, it’s not just the carrot but the stick they may need to resist if they fail to expand Medicaid. Once states expand their programs to the non-disabled, it will be very hard to go back. States find they are on the hook for unanticipated fiscal costs and can no longer try innovative programs to address health insurance problems.

Dean discusses what he learned as a seven-term legislator in the Minnesota House of Representatives. Dean served in leadership roles and had oversight on health care finances. Minnesota was one of the early states to expand Medicaid under Obamacare. He discusses what impact the move has had on the private health insurance market as well as a program the state tried before expansion that actually worked to help the marginalized get better care from hospitals. Dean discusses the kind of pressure “hold out” states are under to expand their Medicaid programs and why that could be a negative thing overall for the country.