After the New Hampshire House of Representatives voted this week to send its Medicaid expansion bill to Democratic governor Maggie Hassan, only five states remain undecided on implementing Obamacare’s controversial Medicaid expansion program.
Since the Supreme Court ruled in 2012 that Obamacare’s mandate expanding Medicaid eligibility to all adults below 138 percent of the federal poverty level must be ratified individually by each state, a fierce pressure campaign has been waged on the state level by left-wing groups like MoveOn.org and hospital interests who stand to gain from the expansion. The Obama administration has been ramping up the pressure, with Health and Human Services Secretary Kathleen Sebelius recently accusing Republican governors of “playing politics with people’s lives.”
Though 19 states, including Rick Perry’s Texas and Bobby Jindal’s Louisiana, have opted to ignore the expansion, a number of Republican governors have caved in. New Jersey’s Chris Christie, head of the powerful Republican Governors Association, Arizona’s Jan Brewer, New Mexico’s Susana Martinez, and Ohio’s John Kasich, who served as House Budget chairman during Newt Gingrich’s speakership and has a Republican-controlled legislature, all approved the Obamacare expansion.
Five states remain in limbo. Their situations include a moderate Republican governor battling his own party, a vulnerable Republican governor up for re-election making major compromises, a liberal Democrat fighting House Republicans to a government shutdown, a conservative governor trying to take federal money without calling it Medicaid expansion, and one state where strong Republicans genuinely have the plan dying in a ditch. Here are the five battlegrounds:
Pennsylvania: Republican governor up for re-election caving fast and caving hard
Corbett has pitched a state-run program that would use federal money to purchase private plans for eligible Pennsylvanians, similar to the plans approved in Arkansas and Iowa. After months of Democratic attacks on his plan’s work-search requirement, Corbett updated his “Healthy Pennsylvania” plan last month, keeping in place the basics but erasing some of the coverage limits included in his first draft. His biggest concession came in a March 5 letter he wrote to Kathleen Sebelius, in which he re-designed his work-search requirement as a one-year pilot program that would give benefits to Medicaid recipients who choose to search for work. “This pilot program will not be a condition of eligibility, but rather those individuals who participate will lower their premiums and cost-sharing as incentives,” Corbett wrote.
Pennsylvania’s Democratic state treasurer Rob McCord, who supports full Medicaid expansion and is running against Corbett in this year’s gubernatorial election, said Monday that he will unilaterally throw out Corbett’s plan if approved in full by the Obama administration and will wait to see which parts of the plan are approved before deciding which ones he will undo. Considering the politics surrounding the 2014 gubernatorial race, in which Corbett is viewed as a relatively weak incumbent facing Republican primary opponents, Corbett’s fight against full Medicaid expansion is looking weaker and weaker by the day.
Virginia: Liberal governor, Republican House, and the road to a summer shutdown
New Democratic governor Terry McAuliffe, who filled his coffers with national money in last fall’s election after making Medicaid expansion his pet project, is locking horns with his Republican-controlled House and looking at a government shutdown this summer over the issue. After McAuliffe and the Democratic-controlled Senate fought Republicans to the end of a regular session without a budget deal, a special session convened Monday with similar results. The House of Delegates under Republican speaker William Howell is trying to force McAuliffe to separate Medicaid expansion from the state’s two-year $96 billion budget plan so they can vote on the bills separately. But the governor isn’t having it.
McAuliffe’s pilot Medicaid expansion program, which he promised however dubiously to cancel after two years if it didn’t show signs of success, was not approved by the House Appropriations Committee Monday, prompting McAuliffe to blast “Washington-style gridlock.” This fight will test McAuliffe’s political clout, but considering the way he nationalized his race against Ken Cuccinelli, over the qq
issue he would face more severe consequences in his own party if he backs down. Get ready for a shutdown.
Utah: Moderate Republican governor fighting his own party
Republican governor Gary Herbert is leading a push to take a nine-figure sum from federal taxpayers despite opposition from legislative leaders in his own party. “Doing nothing is not an option,” Herbert said in January as state interest groups bemoaned the four million dollars per month Utah was losing in federal funding by waiting to expand. Late last month, he introduced his “Healthy Utah” plan, billed as a “Utah Solution,” which would install a state-run program funded by a federal government block grant to finance private plans for citizens below 138 percent of the poverty level. But Herbert’s proposed three-year pilot program, which would use $258 million out of a possible $500 million per year in federal funding available to Utah for Medicaid expansion, was opposed in principle by the state’s Republican-controlled House and Senate.
Republican House speaker Becky Lockhart, who is rumored to be setting up a challenge to Herbert in the 2016 gubernatorial race, instead proposed a limited expansion that would use $35 million in state money and create no new state programs. A competing Senate plan would take only a chunk of the available federal dollars to cover those ineligible for Obamacare subsidies. Undeterred, Herbert last week sent top state officials to Washington to negotiate with the Obama administration. Serving on the executive committee of the bipartisan National Governors Association and touted by the liberal Washington Post as the most popular governor in the country, Herbert seems eager to please national interests but should be wary of alienating his own state party leaders before he tries for a second full term – a decision that he said he will make later this summer, and which could determine the result of the state’s Medicaid fight.
Indiana: Compromise could compromise a rising Republican star
Republican governor Mike Pence, talked about in conservative circles as a 2016 presidential prospect, could compromise his staunch anti-Obamacare credentials and take federal money to expand an existing state program. With Republicans controlling his state’s House and Senate, there’s no chance he’d be forced to cave on Medicaid expansion (“I have no interest in expanding traditional Medicaid in Indiana. I think Medicaid is a deeply flawed system,” he said) but he’s still trying to get his state some of the Obamacare funding that he fought as a congressman to block.
Pence met this month with Kathleen Sebelius to negotiate for his state’s share of Medicaid expansion money to be used to expand the existing Healthy Indiana program, a state insurance plan that provides coverage to about 45,000 people – up from 36,000 after Pence gained an extension waiver for it from the Obama administration late last year. Approximately 50,000 people are on the Healthy Indiana waiting list. It remains unclear whether conservatives will see the distinction between expanding Medicaid and expanding Healthy Indiana. Additionally, Pence’s March letter to Sebelius, in which he discussed their “shared goal of providing high-quality health coverage to more low-income uninsured Hoosiers” and praised Sebelius’ “professionalism,” was seized upon by administration defenders in the mainstream media to make Sebelius look good.
Missouri: Weak Democratic governor getting blocked by Republican Senate
Democratic governor Jay Nixon touted a report Wednesday from the Missouri Hospital Association and the Missouri Chamber of Commerce and called for the Republican-controlled legislature to vote for “expanding and reforming Medicaid.” But there’s only one legislative proposal to expand Medicaid eligibility at all in the conservative state. It’s a House bill sponsored by only seven of 108 House Republicans that has built-in compromises including subsidizing private plans and replacing existing federal payments to state hospitals. On the legislature’s first day back from spring break Monday, five Republican senators vowed on the Senate floor to block, including by filibuster, any Medicaid expansion. “This is done. It’s not happening,” said Sen. John Lamping.
