The country’s battle over Obamacare’s Medicaid expansion is set to grow even harsher in 2015 as Republican-controlled legislatures fight to stop their states from boosting the welfare insurance program.
Over two years after the Supreme Court ruled that Obamacare’s Medicaid expansion could only be optional, rather than mandatory as the law itself had more or less required, just 27 states and Washington, D.C. have agreed to expand Medicaid to include people earning up to 138 percent of the federal poverty line.
That’s not for Democrats’ lack of effort. Every state with a Democratic governor expressed support for a Medicaid expansion, according to the Associated Press, although Democratic governors with Republican-controlled legislatures weren’t able to accept the expansion. Democrat Virginia Gov. Terry McAuliffe spent 2014 in a months-long budget battle with GOP lawmakers about expanding Medicaid and has lost the battle, for now.
That could now become a problem for several Republican governors who are interested in the Medicaid expansion and its influx of federal dollars.
Outgoing Arizona Gov. Jan Brewer is facing a lawsuit from 36 state Republicans, who argue that her expansion plan, which includes a tax on hospitals to fund Arizona’s required contribution, is illegal because it wasn’t passed by a two-thirds majority of the legislature, as tax bills must.
That lawsuit, which has been ongoing, was just boosted by the state Supreme Court, which declined to dismiss the case as the Brewer administration has requested. (RELATED: Court Okays GOP Challenge To Arizona Medicaid Expansion)
More Republican governors are beginning to pick fights with other state officials over the expansion as well. Tennessee Gov. Bill Haslam, who won re-election in November after little real opposition, has since come out in favor of expanding Medicaid, which he says is “morally and fiscally the right thing to do.” (RELATED: Another Red State Moves To Expand Medicaid)
GOP governors are trying to sell their expansions as different from the unpopular health-care law. Some governors have introduced private coverage options; others are considering charging small co-pays or premiums to assure some level of accountability. Distinguishing the expansion from Obamacare remains a difficult divide to straddle, however. Medicaid expansions in just half the country account for the vast majority of newly-insured Americans as a result of the law.
Haslam says his plan “is not Obamacare.” He announced in December that his plan will feature vouchers for employer-sponsored coverage and required co-pays as conservative additions to the program. Republican State Sen. Brian Kelsey doesn’t think the tweaks are enough, telling the AP that voters want Haslam to shrink government, not grow it.
Alaska’s independent governor-elect Bill Walker and North Carolina’s GOP Gov. Pat McCrory also support accepting the Medicaid expansion package, but only if they can get it past their GOP legislatures’ opposition, the AP reports. The same goes for Wyoming Gov. Matt Mead, who now supports an expansion, but in a different form from the GOP-controlled legislature’s preferred plan.
While Haslam’s trying to win over some Republicans with conservative changes to the Obama administration’s version of the Medicaid expansion, Republican governors have a thin line to walk with modifications. They’ve got to come up with a program that passes muster not only with state legislatures, but with the Obama administration as well.
Indiana Republican Gov. Mike Pence has spent a year attempting to expand Medicaid, but the Department of Health and Human Services hasn’t yet accepted his version of the expansion, which would charge a very small monthly premium.
Even if the Obama administration gets on board with modified expansions, plans could still fall through.
In 2015, Arkansas may become the first state to revoke its Medicaid expansion. Gov. Mike Beebe pioneered a version of an expansion with a private option for Medicaid coverage and in its first year, the program has cost $778 million more than traditional Medicaid would have. (RELATED: Federal Report Slams Obama Admin For Underestimating Cost Of Arkansas Medicaid Expansion)
And after Republicans made large gains in the November elections, cementing their previous majorities, some lawmakers are talking about ending the expansion. Governor-elect Asa Hutchinson hasn’t yet taken a position on the expansion himself.