Little Reason for Optimism in Red State Medicaid Expansion

For months several Wall Street analysts and others have predicted near-total adoption of the Affordable Care Act’s Medicaid expansion by the states.  To date, only 27 have, and I see little optimism for more than a handful to do so anytime soon.

Red State governors are WAY more entrenched than anyone anticipated, and they’re getting too much political mileage out of throwing a middle finger at the guy in the White House to stop. Even if Democratic candidates leading in states like Florida win next week, the barrier is often their state legislatures.  Virginia is a great example of a pro-expansion Democrat thwarted by his state lawmakers — one that will be repeated many times in 2015.

Last week we heard mixed news on Medicaid expansion: it appeared likely that Utah governor Mike Herbert would accept an Arkansas-style expansion in a rare compromise with the Obama Administration, and also pretty certain that Indiana governor and 2016 GOP Presidential possible Mike Pence would reject one.  Even if Herbert takes the deal, Utah may be another example like Virginia, with a supportive governor blocked from expanding by his state house.

At least six states could adopt Medicaid expansion, including Florida, Georgia, Kansas, Maine, Wisconsin and Alaska, if — and it’s a huge if given the political headwinds — Democrats and one independent candidate win their gubernatorial races. The obstacle is getting state lawmakers on board in Florida, Georgia, Wisconsin and Kansas, where Republicans control the legislature.

So maybe it’s really just Maine and Alaska that have any real shot at expansion? Maine lawmakers are poised to expand Medicaid if Tea Party wingnut Governor Paul LePage is defeated next week. LePage has vetoed several bills to expand the program after they were passed by the Democrat-controlled Maine legislature, and he is trailing in the latest polls. Alaska isn’t nearly as far along.

A handful of new Republican governors could move for expansion, albeit after the midterm elections. Tennessee GOP Governor Bill Haslam said he plans to submit a plan later this year, although state Republican leaders warn it will be difficult to win approval. Wyoming Governor Matt Mead, also a Republican, said he will present an expansion plan to his legislature early next year, but prospects also seem slim there.

In many of the remaining Red States, where uninsurance is most epidemic and the ACA is needed most, there seems to be little hope of elected officials actually doing their jobs and meeting the needs of their constituents:

  • In Mississippi, expansion doesn’t have a snowball’s chance in Hell.  GOP Governor Gary Bryant made it clear Mississippi would not participate, leaving 138,000 residents, the majority of whom are black, with no insurance options at all after infighting killed the state’s embryonic health insurance exchange.
  • In South Carolina, where expanding Medicaid could reduce the number of people without health insurance by one-third, the state’s health plan association doesn’t expect any movement until at least 2017.  Even its state medical association won’t back expansion, apparently preferring bad debt and fewer customers to Medicaid payment.
  • In Louisiana, payers aren’t hostile to expansion, they just don’t see any point in pushing it. The state health plan association chief said “it’s a state where both the House and the Senate, and the governor, are pretty much on the same page of not being interested in moving toward expansion this year or next year.”
  • In Alabama, even the state’s health plan association is openly opposed to expansion. “I agree, and I think my members agree, that [Governor Robert] Bentley is doing the right thing” by saying no, the association CEO said. In its current form, “expanding Medicaid makes zero sense for Alabama.”
  • In Texas, which has more uninsured people than Colorado has people? Um, no.

With Republicans poised to retake the US Senate next week and expand their dominance in the House, all this hopeful chatter about Medicaid expansion seems more like liberal dreaming than reality. Maybe 2-3 more states in the next two years, if we’re lucky.

 

Resources

Gorman Health Group, LLC (GHG), the leading consulting firm and solutions provider in government health care programs, announced its further expansion into Medicaid, and the promotion of one of the nation’s leading Medicaid experts, Heidi Arndt, to lead the division. Read more >>

GHG is dedicated to assisting managed care organizations, as well as states with developing models of care, maximize member engagement. Visit our website to learn more >>

Save the Date for the Gorman Health Group 2015 Forum. Join us April 7-9, 2015 at the Gaylord National Resort and Convention Center in National Harbor, MD. Learn more about the event >>