Tuesday, March 28, 2017

More states look at expanding Medicaid now that the tool for it, Obamacare, remains on the books

The failure of Republicans' "repeal and replace Obamacare" bill, and House Speaker Paul Ryan's forecast that the law will remain on the books for the foreseeable future, has prompted Republicans in states that did not expand Medicaid to take another look at the idea, reports James Hohmann of The Washington Post.

"The bill that was being considered in the House would have phased out the expansion under the 2010 law, which has already grown the Medicaid rolls by more than 11 million people," Hohmann writes. "It could have left states holding the bag over the next couple of years. With Obamacare repeal less likely, opponents of expansion in the states have just lost their best argument." The federal government pays 100 percent of initial expansion costs; the law lowers that to 90 percent by 2020.

The Kansas Senate is about to cast a final vote to expand Medicaid, and while Gov. Sam Brownback has promised a veto, "He’s also expected to soon get appointed to an overseas posting by President Trump. So the legislature might be able to try again soon," Hohmann writes. Or maybe they won't have to. Jonathan Shorman of The Wichita Eagle reports, "The House vote and the initial Senate vote are just shy of the number needed to override a veto."

"In Georgia, Republican Gov. Nathan Deal announced yesterday that his administration is exploring changes to the state’s Medicaid program now that the House bill has gone down," Hohmann reports. "In Virginia, meanwhile, the failure of Congress has emboldened Democratic Gov. Terry McAuliffe to renew his stalled crusade to expand Medicaid." Bruce Japsen of Forbes magazine says expansion efforts could be revived in North Carolina, Idaho, Nebraska and South Dakota, and The Huffington Post notes that Maine voters will decide the issue in a referendum this fall.

Hohmann notes "a good story" in The New York Times that notes the number of people on Medicaid is greater than those on Medicare, with which it was created in 1965: “In 2015, the nation spent more than $532 billion on Medicaid, of which about 63 percent was federal money and the rest from the states. … Medicaid now provides medical care to four out of 10 American children. It covers the costs of nearly half of all births in the United States. It pays for the care for two-thirds of people in nursing homes. And it provides for 10 million children and adults with physical or mental disabilities. For states, it accounts for 60 percent of federal funding — meaning that cuts hurt not only poor and middle-class families caring for their children with autism or dying parents, but also bond ratings.”

UPDATE, March 29: The Arkansas Senate voted to extend the state's hybrid Medicaid expansion.

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