States Holding Out on Medicaid Expansion Are Beginning to Crack

New Hampshire could be the first of many to sign on.

National Journal
Lucia Graves
March 21, 2014, 1 a.m.

As Planned Par­ent­hood sup­port­ers ral­lied out­side Flor­ida Gov. Rick Scott’s of­fice earli­er this week, state Sen. Arthenia Joyn­er lashed out at op­pon­ents of Medi­caid ex­pan­sion. Stand­ing at a wooden lectern, sur­roun­ded by scores of wo­men, she crossed party lines to stump for a bill that would in­crease the num­ber of poor Flor­idi­ans covered by Medi­caid.

“We need to pass Sen. Gar­cia’s bill,” the Demo­crat told the gathered masses, re­fer­ring to a pro­pos­al in­tro­duced by her Re­pub­lic­an col­league Rene Gar­cia. “It was good enough for the speak­er’s fam­ily,” she ad­ded, re­fer­ring to a time when Re­pub­lic­an House Speak­er Will Weather­ford’s fam­ily had re­lied on med­ic­al as­sist­ance to pay for his broth­er’s can­cer treat­ments. “By golly, it’s good enough for all of the fam­il­ies of Flor­ida.” That story, first re­por­ted in The Tampa Tribune, is just the latest sign that Obama­care’s Medi­caid ex­pan­sion ef­fort has reached a tip­ping point.

With 25 states and the Dis­trict of Columbia opt­ing in to Medi­caid un­der the Af­ford­able Care Act and an­oth­er six in limbo, the tu­mult in a hand­ful of hol­d­out states is in­creas­ing. The White House hopes un­rest in states like Flor­ida, New Hamp­shire, Neb­raska, and Maine will help turn the fight de­cidedly in their fa­vor. And there’s good reas­on to think that’s hap­pen­ing.

New Hamp­shire, a state that was non­com­mit­tal on Medi­caid ex­pan­sion, is now on the brink of ex­pand­ing cov­er­age to ap­prox­im­ately 50,000 poor res­id­ents. The Re­pub­lic­an-con­trolled Sen­ate voted to pass a state-mod­i­fied ver­sion of ex­pan­sion earli­er this month. And, on Tues­day, a House pan­el en­dorsed the mo­tion. The Demo­crat­ic-con­trolled House is ex­pec­ted to pass the bill in a vote next week.

In Vir­gin­ia, Demo­crat­ic Gov. Terry McAul­iffe has been fight­ing for Medi­caid ex­pan­sion since he was elec­ted in Novem­ber (the Re­pub­lic­an-led House is op­posed). Ten­sions came to a head this week­end when sev­er­al hun­dred demon­strat­ors gathered out­side the state Cap­it­ol in Rich­mond to rally for Medi­caid ex­pan­sion, car­ry­ing signs that read “We need Medi­caid ex­pan­sion now” and “Get sick, go broke, un­ac­cept­able!”

In Pennsylvania, Re­pub­lic­an Gov. Tom Corbett had ori­gin­ally pro­posed a mod­i­fied ver­sion of the pro­gram, ty­ing in a con­tro­ver­sial re­quire­ment that mad­ated those work­ing few­er than 20 hours per week par­ti­cip­ate in a job-train­ing pro­gram to qual­i­fy for cov­er­age. The gov­ernor has since sub­mit­ted a softer pro­pos­al that “re­stores some be­ne­fits” and drops the work-search re­quire­ment in fa­vor of a vol­un­tary pi­lot pro­gram. That plan, cur­rently un­der re­view by the fed­er­al gov­ern­ment, is un­likely to win sup­port from Wash­ing­ton, giv­en Corbett’s stip­u­la­tions.

Rep­res­ent­at­ives for Utah Gov. Gary Her­bert traveled to D.C. this week to dis­cuss Medi­caid ex­pan­sion ef­forts with ad­min­is­tra­tion of­fi­cials. The gov­ernor, who ini­tially re­frained from opt­ing in, in Janu­ary vowed to take ac­tion on Medi­caid ex­pan­sion, say­ing while he op­poses Pres­id­ent Obama’s health care law, the state has an ob­lig­a­tion to help its poor. But his pro­pos­al, a “block grant” op­tion that would use fed­er­al dol­lars to cov­er the poor in private plans, failed to win the sup­port of Re­pub­lic­an lead­ers in the House and Sen­ate. The Salt Lake Tribune re­ports that “though he lacks the back­ing of the Le­gis­lature, law­makers haven’t tied his hands.” Her­bert ad­visers meet­ing with the Obama ad­min­is­tra­tion this week in­clude Wes­ley Smith, dir­ect­or of state and fed­er­al re­la­tions; Dav­id Pat­ton, head of the state’s De­part­ment of Health; and staff mem­bers from the Health De­part­ment’s Medi­caid of­fice, ac­cord­ing to the Deser­et News.

Move­ment in Mis­souri has been sty­mied by a stan­doff between Demo­crat­ic Gov. Jay Nix­on, an ad­voc­ate of ex­pan­sion, and the state’s GOP Le­gis­lature. But even there, the dy­nam­ic is start­ing to shift. KCUR.org re­por­ted Tues­day that Mis­souri politi­cians “might be inch­ing to­ward middle ground that would ex­pand Medi­caid eli­gib­il­ity while re­form­ing the safety-net pro­gram to en­cour­age re­cip­i­ents to work,” ac­cord­ing to two key par­ti­cipants in the talks. Le­gis­la­tion pending in the House is sched­uled for a hear­ing on on March 25.

These stor­ies of in­cre­ment­al pro­gress can also be found in states that have re­jec­ted Medi­caid ex­pan­sion out­right, a de­cision states may change at any time. In Neb­raska, the Le­gis­lature is bat­tling it out over ex­pan­sion with on­look­ers like Demo­crat­ic gubernat­ori­al can­did­ate Chuck Hassebrook,who is ur­ging state law­makers to pass a bill that would ex­pand cov­er­age to some 54,000 un­in­sured Neb­raskans. Small protests have be­gun in South Car­o­lina, with demon­strat­ors gath­er­ing out­side the State House park­ing gar­age weekly to protest the state’s de­cision not to ac­cept fed­er­al Medi­caid money. (On Tues­day, the 16 pro­test­ers were sent to court for ob­struct­ing traffic.) And in Maine, state law­makers have backed a com­prom­ise on Medi­caid ex­pan­sion but fell just short of the veto-proof ma­jor­ity needed to get it past Re­pub­lic­an Gov. Paul LePage. (Maine’s ver­sion of the bill would ex­pand the state Medi­caid pro­gram to provide health care cov­er­age for 60,000 to 70,000 in­di­vidu­als earn­ing just over $15,856 a year.)

No doubt many of these bills will con­tin­ue to be sty­mied for some time — vir­tu­ally all of them by people with the means not to rely on such in­sur­ance. And plenty of con­ser­vat­ive crit­ics will con­tin­ue to rage that Medi­caid ex­pan­sion is “sin­ful” and that the Af­ford­able Care Act is “a plot to des­troy the fam­ily.” But it’s look­ing in­creas­ingly like time is not on their side.

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