Medicaid Expansion Again Takes Center Stage

As in years past, Medicaid expansion is quickly shaping up to be the top health policy issue in many of the states this year and the one that state legislators will undoubtedly spend the most time debating. One of the key provisions of the ACA, or Obamacare, was an expansion of the federal government’s Medicaid program to cover all those under 65 who make less than 138 percent of the federal poverty level (FPL) on an annual basis. As a result of the 2012 Supreme Court case National Federation of Independent Business v. Sebelius, states were granted the right to choose whether or not they would participate in this expansion. Most blue states chose to do so, while most red states have been vehemently opposed.

The notion of expanding Medicaid has long been toxic to many state-level GOP lawmakers who want to see the President’s signature healthcare law repealed and replaced. However, these legislators must also grapple with the prospect of potentially leaving billions of dollars in guaranteed federal funding on the table. This money has caused numerous Republican governors and legislators to take a harder look at the option and could provide their budgets and economies with a much needed cash infusion. Arizona, Ohio and Pennsylvania, all states with both Republican governors and legislatures at the time, chose to expand the program last year. Proposals in Indiana, Tennessee, Utah and Wyoming are being considered as well.

The proposals in these red states are uniquely negotiated and avoid using the term ‘Medicaid’ at all, even though they fulfill the same goal in closing the so-called ‘coverage gap’ for those making between 100 percent and 138 percent FPL. This group qualifies for neither Medicaid nor subsidies to buy health insurance on a state or the federal exchange.

Medicaid States

To date, 27 states and the District of Columbia have gone forward with this expansion. However, 23 states, nearly all of them GOP bastions, have so far refused to expand the program, though many are set to relent and consider proposals. Below are some of the states most likely to consider expanding the program in 2015:

  • Alabama has expressed that he may support the seeking of a block grant from the federal government for the purpose of expanding Medicaid, which is in stark contrast to his campaign platform opposing Medicaid expansion. Governor Bentley is seeking an alternative expansion plan similar to those brokered in other GOP strongholds.
  • Alaska newly-elected Independent Gov. Bill Walker campaigned on the promise that he would expand Medicaid as one of his first tasks as governor. He will face strong opposition from the Republican legislature.
  • Florida may have the potential to expand its Medicaid program in 2015, an effort that would provide health coverage to nearly 700,000 people. A plan known as A Healthy Florida Works has been gaining traction with GOP legislators and may offer a viable way to fill both the coverage gap and looming budgetary gap.
  • Indiana Republican Gov. Mike Pence says he will not expand the state’s regular Medicaid program because it is “broken,” but he intends to implement an improved version of the Healthy Indiana Plan pilot program that was first implemented in 2008.
  • In February 2014, the Missouri Senate defeated an effort to expand Medicaid. Democratic Gov. Jay Nixon favors the expansion, and Sen. Ryan Silvey, R-Kansas City, says he has support for an expansion proposal in 2015.
  • Montana legislators are reportedly gearing up for another fight over the expansion of Medicaid, as they fell one vote short of doing so in 2013. Democratic Gov. Steve Bullock has thrown his support behind a plan known as the “Healthy Montana Plan” in the upcoming legislative session.
  • Tennessee Republican Gov. Bill Haslam, incoming chair of the Republican Governor’s Association, unveiled a program in December known as “Insure Tennessee,” the state’s own personalized take on expanding Medicaid. The plan is likely to face pushback from conservative lawmakers, though the governor and his staff are hopeful that they will be able to pass a plan this year.
  • Texas Republican Governor-elect and current state Attorney General Greg Abbott surprised many conservatives in his own party when he asked for more information about a compromise recently struck by the federal government and Utah’s Republican Gov. Gary Herbert. The state currently has the largest number of uninsured residents that would potentially be covered under an expansion of Medicaid.
  • Utah Republican Gov. Gary Herbert recently proposed his own alternative proposal to Medicaid expansion, known as “Health Utah.” However, it will face an uphill battle with conservative members of the legislature after its Health Care Reform Task Force chose not to recommend the plan be heard before the full body, according to The Salt Lake Tribune.
  • Virginia will once again take up the issue of Medicaid expansion after last year’s dramatic failure that saw members of the Senate allegedly bribed by both conservative Republicans and the governor’s own Chief of Staff. The issue was narrowly defeated as the balance of power in the Senate shifted to Republicans, who have vowed to continue to fight any expansion in the state.
  • Wyoming Republican Gov. Matt Mead is urging the Republican-controlled legislature to approve a new plan set forth by the state Department of Health, one year after rejecting federal funds to expand Medicaid. According to the governor, the state must be “realistic” in accepting Medicaid expansion as the law of the land. Wyoming has negotiated with the federal Department of Health and Human Services to come up with their own version of Medicaid expansion, the Strategy for Health, Access, Responsibility and Employment (SHARE) plan.