How GOP Governors Can Make Peace With Obamacare’s Medicaid Expansion

Hint: Don’t call it Medicaid expansion. Or Obamacare.

House Republican Conference Chairman Mike Pence looks out over the crowd as US President Barack Obama answers a question at the Republican GOP House Issues Conference in Baltimore, Maryland, January 29, 2010. AFP PHOTO / Saul LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
National Journal
Sophie Novack
Add to Briefcase
Sophie Novack
May 19, 2014, 9:43 a.m.

Re­pub­lic­an In­di­ana Gov. Mike Pence wants to re­peal Obama­care. But in the mean­time, he’ll ac­cept fed­er­al funds for the health law’s Medi­caid ex­pan­sion.

Pence an­nounced in a turn­around last week that he would take the ex­pan­sion money to grow the state’s own pro­gram — the Healthy In­di­ana Plan — to cov­er low-in­come in­di­vidu­als who would qual­i­fy for tra­di­tion­al Medi­caid un­der the Af­ford­able Care Act’s Medi­caid ex­pan­sion.

But he wants to make his op­pos­i­tion to the health law — and com­mit­ment to re­peal — very clear.

“Obama­care needs to be re­pealed for many reas­ons, in­clud­ing that it is push­ing a massive, flawed Medi­caid pro­gram onto states,” Pence said at an Amer­ic­an En­ter­prise In­sti­tute event Monday. Once Obama­care is re­pealed, [In­di­ana’s] con­sumer-driv­en plan will serve as a mod­el for what block-gran­ted Medi­caid pro­grams can be in states across the coun­try.”

Obama­care calls for the ex­pan­sion of Medi­caid cov­er­age to all in­di­vidu­als be­low 138 per­cent of the fed­er­al poverty level, but the Su­preme Court left the de­cision to the states. Twenty-six states plus D.C. have op­ted in­to ex­pan­sion, but a hand­ful of red states have re­frained, in protest against the en­ti­tle­ment pro­gram and the health care law.

Re­pub­lic­an gov­ernors have found them­selves in sticky ter­rit­ory — want­ing to avoid a cov­er­age gap in their state, but more vehe­mently want­ing to avoid giv­ing their im­pli­cit stamp of ap­prov­al to Obama­care.

Some, like Pence, have tried to find work­arounds that would take the fed­er­al fund­ing and ex­pand cov­er­age to low-in­come res­id­ents, but through a private, mar­ket-based ap­proach that is more pal­at­able to Re­pub­lic­ans. Arkan­sas led the way with its “private op­tion” plan, and oth­ers, such as Pennsylvania and In­di­ana, have fol­lowed suit.

The In­di­ana al­tern­at­ive — HIP 2.0 — would ex­pand on the ex­ist­ing state pro­gram, and in­clude three dif­fer­ent plan op­tions: HIP Link, HIP Plus, and HIP Ba­sic. All in­clude a Per­son­al Well­ness and Re­spons­ib­il­ity, or POWER, ac­count that is in­ten­ded to func­tion like a Health Sav­ings Ac­count; re­quire a con­tri­bu­tion from the pa­tient; and em­phas­ize pre­ven­tion, with a pen­alty for un­ne­ces­sary emer­gency-room use. They are in­ten­ded to be tem­por­ary plans, un­til con­sumers are able to work their way up to trans­ition in­to the private in­sur­ance mar­ket­place, Pence says.

HIP Link is a premi­um as­sist­ance pro­gram for people with ac­cess to em­ploy­er-based cov­er­age but who may not be able to af­ford the plans. HIP Plus is for in­di­vidu­als be­low 138 per­cent of the fed­er­al poverty level who make their POWER con­tri­bu­tions, while HIP Ba­sic is for those be­low 100 per­cent FPL who do not make their re­quired con­tri­bu­tions. HIP ba­sic in­cludes a less com­pre­hens­ive be­ne­fits pack­age and pre­scrip­tion-drug be­ne­fit. Those above 100 per­cent FPL risk los­ing their cov­er­age en­tirely if they don’t make their con­tri­bu­tion; those be­low 100 per­cent must make co-pays and re­ceive few­er be­ne­fits un­til they are able to con­trib­ute again.

Pence in­sists that his pro­posed ex­pan­sion of the Healthy In­di­ana Plan is not Medi­caid ex­pan­sion, and is not Obama­care. But he is seek­ing to pay for the pro­gram us­ing Obama­care dol­lars, even as he con­tin­ues to call for the law’s re­peal.

Of course, if Obama­care were re­pealed, Pence would not have the fund­ing he seeks to im­ple­ment HIP 2.0.

The In­di­ana pro­pos­al is cur­rently in the com­ment peri­od, and Pence plans to sub­mit the waiver ap­plic­a­tion to CMS some­time next month. The fed­er­al gov­ern­ment will need to ap­prove the re­quest in or­der for the plan to move for­ward.

“We haven’t shaken hands on this deal yet,” Pence said. “But I’m hope­ful.”

What We're Following See More »
ANOTHER NUCLEAR OPTION?
Byrd Rule Could Trip Up Health Legislation
8 hours ago
THE DETAILS

"Even if House Republicans manage to get enough members of their party on board with the latest version of their health care bill, they will face another battle in the Senate: whether the bill complies with the chamber’s arcane ... Byrd rule, which stipulates all provisions in a reconciliation bill must affect federal spending and revenues in a way that is not merely incidental." Democrats should have the advantage in that fight, "unless the Senate pulls another 'nuclear option.'”

Source:
ONE WEEK
Senate Votes To Fund Government
11 hours ago
BREAKING
ON TO SENATE
House Passes Spending Bill
12 hours ago
BREAKING

The House has passed a one-week spending bill that will avert a government shutdown which was set to begin at midnight. Lawmakers now have an extra week to come to a longer agreement which is expected to fund the government through the end of the fiscal year in September. The legislation now goes to the Senate, where it is expected to pass before President Trump signs it.

PRESIDENT CALLS MEDICAID FUNDS A “BAILOUT”
Puerto Rico Another Sticking Point in Budget Talks
1 days ago
THE DETAILS

President Trump’s portrayal of an effort to funnel more Medicaid dollars to Puerto Rico as a "bailout" is complicating negotiations over a continuing resolution on the budget. "House Democrats are now requiring such assistance as a condition for supporting the continuing resolution," a position that the GOP leadership is amenable to. "But Mr. Trump’s apparent skepticism aligns him with conservative House Republicans inclined to view its request as a bailout, leaving the deal a narrow path to passage in Congress."

Source:
POTENTIAL GOVERNMENT SHUTDOWN?
Democrats Threaten Spending Bill Over Obamacare
1 days ago
BREAKING

Democrats in the House are threatening to shut down the government if Republicans expedite a vote on a bill to repeal and replace Obamacare, said Democratic House Whip Steny Hoyer Thursday. Lawmakers have introduced a one-week spending bill to give themselves an extra week to reach a long-term funding deal, which seemed poised to pass easily. However, the White House is pressuring House Republicans to take a vote on their Obamacare replacement Friday to give Trump a legislative victory, though it is still not clear that they have the necessary votes to pass the health care bill. This could go down to the wire.

Source:
×
×

Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.

Login