Medicaid Expansion after the Midterms: State Stances Unlikely to Change, or New Room for Compromise between the Administration, GOP Governors?
Posted Dec. 2, 2014 | Following a strong Republican showing at the midterm elections and in many gubernatorial races, commentators and experts alike have suggested the states’ stances on Medicaid expansion are firm and unlikely to change. Of the 23 states that have not expanded their Medicaid programs, six had contentious gubernatorial races that were won by the Republican candidate: Florida, Georgia, Kansas, Maine, South Dakota, Wisconsin and Wyoming. All six of those states will have governors in January that either oppose Medicaid expansion outright or have supported it absent a forceful push (Florida). Perhaps preparing for just such an outcome, Health and Human Services Secretary Sylvia Matthews Burwell spoke recently at a meeting of states’ Medicaid directors, sharing that working “with states that have yet to expand” was among the federal department’s “top priorities” (Elise Viebeck, “Health chief ‘eager’ to expand ObamaCare with new governors,” The Hill, November 4).
Perhaps reflecting both the political reality and Burwell’s open-door policy, a slew of recent opinion pieces have appeared in the major newspapers of non-expansion states, such as Missouri, Tennessee and Texas, with changes in staff and policy direction in the news in others (Pennsylvania and Wyoming); see below the fold.
What’s your take? Will the recent slew of Republican wins freeze state decisionmaking on Medicaid expansion for the next two-to-four years, or has Burwell’s statement created new room for compromise and progress on expansion between the Administration and GOP governors?
View the Report
Wyoming health department backs plan to expand Medicaid (Wyoming Tribune Eagle, Nov. 27)
The state agency released a report recommending that the State accept a modified version of the optional Medicaid expansion. “The state of Wyoming has thousands of residents without health coverage … and they are out of luck unless the state elects to expand,” said Department of Health Director Tom Forslund. “And here is an opportunity for the state to expand at essentially no cost to the state’s general fund.”
Former Pennsylvania welfare secretary Estelle Richman tapped to lead Governor-elect Tom Wolf’s Medicaid expansion pursuit during transition (The Patriot-News, Nov. 21)
Richman’s role on the transition team entails leading efforts to fully expand Medicaid and undo changes that were part of outgoing Governor Tom Corbett’s version of the Medicaid expansion.
Expanding Medicaid is vital to Missouri’s health (Springfield News-Leader, Nov. 16)
“It appears that opponents to Medicaid expansion, after making arguments about costs of the program and need for reform, have simply chosen to not mention it in the upcoming session and hope it will go away. … As it stands now, without Medicaid expansion, our federal tax dollars are now being lost to states in which Medicaid expansion has occurred. Missouri is losing approximately $5 million per day. With Medicaid expansion, the costs of uncompensated care by the state and local governments will decrease markedly.” (Dr. John Mihalevich)
Expansion of Medicaid can save rural hospitals (The Tennessean, Nov. 18)
“In Tennessee, inaction on Medicaid has meant the loss of nearly $1 billion in federal funds, a number that grows by $2.5 million each day. This money would not have gone into some unnamed bureaucracy; it would have been used to provide quality, affordable health-care coverage to the 300,000 Tennesseans who fall in the Medicaid gap. The benefits of Medicaid expansion aren’t limited to the health of those individuals. Providing this coverage means that 300,000 people can go see a doctor on a regular basis, limiting their need for emergency care at hospitals. When these individuals did need ambulatory care, the admitting hospital would receive a Medicaid reimbursement rate for their services, which currently they have to write off as charity care.” (Tennessee state Rep. Craig Fitzhugh and state Sen. Jeff Yarbro)
Hospitals seek a Texas way to expand Medicaid (Dallas Morning News, Nov. 18)
“Expanding Medicaid may be anathema to Texas political leaders. For hospitals, though, it would be a godsend. … Gov. Rick Perry and others have said Texas is not interested in pouring more money into a broken system. One way health care providers agree that Medicaid is broken is in the meager amount this state-federal partnership program pays for care. Hospitals say they lose money on every Medicaid patient they treat.” (Jim Landers)