Health Care Reform Remains On Center Stage

In deep-red Georgia, legislators have introduced a bill that attempts to block implementation of the federal Affordable Care Act (ACA). HB 707, which is currently awaiting consideration in the House Judiciary Committee, would prohibit the state from participating in any health care exchange and preclude any state or local government agency or employee from actively aiding in the enforcement of the ACA.

The bill could easily become law. It has several sponsors in the predominantly GOP-controlled committee and the legislature is controlled by Republicans. Governor Nathan Deal has been a vocal opponent of the ACA, so the bill could be signed into law setting up yet another ACA-related showdown in the courts.

Several other states are expected to consider ACA-related legislation this year much of it related to the botched rollout of the state health exchanges and Medicaid expansion. Medicaid expansion has strong support among lawmakers in the deep-blue west coast and northeastern states. Lawmakers in the south, however, remain skeptical. To date not a single state south of the Mason Dixon line has acted to expand its Medicaid programs.

In spite of this, there are signs that the ACA is maturing or perhaps opposition is waning.  For example, states, most likely eager for the federal dollars attached to the law, are looking at bipartisan alternatives to break the gridlock that has sidetracked Medicaid expansion. States to watch this year include:

Florida Senate Republicans have submitted a proposal this year which would use federal Medicaid dollars to buy health insurance for the poor, though the sponsor, Sen. Rene Garcia, has admitted that the bill is a longshot. A similar proposal last year passed the Senate nearly unanimously and also won the support of Republican Gov. Rick Scott, however it failed to pass the very conservative 120-member House.

Maine Democrats, who control the legislature, passed a measure to expand Medicaid last year, but it was predictably shot down by the governor. This year, Democrats are trying to build a bipartisan coalition to pass a bill that would expand the states Medicare in a way acceptable to both sides with a veto proof majority. Anything less than a veto proof majority is doomed to failure. Governor Paul LePage, a Tea Party conservative, used his veto authority a staggering 665 times last year. He can be expected to use it if Medicaid expansion reaches his desk again.

A New Hampshire plan to expand Medicaid could not pass the Republican controlled Senate during a November special session called by Democratic Gov. Maggie Hassan for the explicit purpose of expansion. Republican Senate Leader Jeb Bradley has stated he is confident the two sides can come to an agreement this year, however.

Virginia’s newly elected Democratic Governor Terry McAuliffe is likely headed towards a collision course with its GOP controlled legislature – the governor has said publically that he will not support a budget that does not included Medicaid expansion, while Republican Speaker William Howell has called for Virginia to reign in its already high Medicaid costs, which he accurately claims have risen 1,600 percent over the past 30 years.