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 Up to a dozen states, including several led by Republicans, could
move forward with plans to expand coverage under Medicaid after the
November elections. They take their cue from Pennsylvania and other
states that have won Washington's approval to add commercial
innovations to the 50-year-old government program to make it more
palatable to conservatives.
Obama's original idea of using tax money to expand Medicaid has long
been a hot button for Republicans who portray the whole Obamacare
healthcare overhaul as a form of socialism encroaching on American
values of free enterprise and self-reliance. Texas Governor Rick
Perry once said expanding Medicaid would be similar to "adding a
thousand people to the Titanic.”
But two things have led to a change of heart for some Republican
politicians.
Most of the 27 states that are already expanding the program have
begun to reap billions in federal subsidies for insurers, hospitals
and healthcare providers, putting politicians elsewhere under
intense pressure to follow suit.
As demonstrated by Pennsylvania's deal with Washington, the Obama
administration has also proved willing to accept tweaks that give
the private sector a greater role in providing healthcare and place
new responsibilities on beneficiaries.
All of that has got as many as nine states talking to the
administration about potential expansion terms, with the possibility
of up to three more joining the fray depending on November's
election outcomes. As a result, there could be even more pressure on
Republican states that have opted out, providing critical mass for
an initiative central to Obamacare.
Heading into the final two years of his presidency, Obama wants to
cement his legacy, a big part of which is his pledge to reduce the
number of uninsured Americans.
NEW WAVE
“Pennsylvania’s the leading edge of what could be a new wave of
expanding states,” said Deborah Bachrach, a Medicaid expert at the
law and consulting firm Manatt, Phelps & Phillips.
“This would marginalize the non-expansion states to the considerable
detriment of their citizens and put pressure on those who oppose
expansion,” she said.
Some states with Republican governors, such as Indiana, are
negotiating with Washington for agreements that could pass political
muster with conservatives back home. Others such as North Carolina,
South Dakota and Wyoming are exploring options.
In Florida, Wisconsin and Maine, the outcome of the Nov. 4 election
could bring a shift on Medicaid if Democrats win gubernatorial races
there.
Administration officials have said they are committed to working
with all states to expand the scheme and noted that the number of
the uninsured has declined much more in states that have expanded
Medicaid coverage.
A possible new wave of expansion comes as prospects for the broad
Obamacare reform are also looking up. After a rocky start a year
ago, research suggests that more than 10 million people have gained
health coverage under the law.
But that momentum could get lost if Republicans win control of the
U.S. Senate and begin pressuring Obama to scale back the reform.
Pennsylvania's turbulent journey into the Medicaid fold offers a
possible template for others, including the possibility of a
political reversal if Republican Governor Tom Corbett loses his
reelection bid. In polls, he is well behind Democratic challenger
Tom Wolf, who favors expanding Medicaid and keeping its traditional
structure intact.
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Corbett, who took part in a Supreme Court challenge to the Medicaid
expansion, had opposed enlarging a government program without
substantial change. A pro-Medicaid coalition of more than 100 groups
responded with intense lobbying during the budget approval process
in early 2013.
“We had advocacy days, drive-ins, invited lawmakers in to talk about
what’s important, encouraged people to talk to their local chambers
of commerce and organized educational opportunities,” said Paula
Bussard, policy chief at the Hospital & Healthsystem Association of
Pennsylvania, which represents 250 institutions.
A study by the RAND Corp predicted a $3 billion economic boost and
the creation of 35,000 jobs – big advantages for a state that has
struggled for decades to make up for jobs lost from the decline of
the coal and steel industries.Corbett met in Washington with former
U.S. Health and Human Services Secretary Kathleen Sebelius in April
2013 and a year of intensive talks followed.
Pennsylvania won approval for only a handful of the two dozen
innovations it sought, such as permission to offer benefits through
private insurers and impose premium charges on beneficiaries who
earn more than the federal poverty level.
The program will also include incentives for beneficiaries to
practice healthy behavior including screenings and set benefit
packages according to commercial standards.
Pennsylvania officials say that while a compromise proved possible,
that did not mean convergence in political positions.
“The administration comes from a different philosophical
background,” said Jennifer Branstetter, Corbett’s policy chief.
“They want to make sure that the program’s there for everybody. And
we want to make sure it’s there if you need it."
Other Republican-led states hope the Obama administration will allow
even greater flexibility.
“The hope is that they'll be less interested in the purity of their
original vision and be more interested in cutting deals to get some
of these things done," said Tony Venhuizen, spokesman for South
Dakota’s Republican Governor Dennis Daugaard, who has been open to a
Medicaid expansion.
In some states, pro-expansion politicians are trying to win
conservative support by pushing market-based innovations that over
time could trim the cost of traditional Medicaid.
"Eventually, they could meld together," said Nebraska Senator Kathy
Campbell, a Republican who has helped lead discussions with
Washington.
But while the turning tide on Medicaid bodes well for Obamacare,
Republicans refuse to concede any points in the ideological battle
around the healthcare model.
(Reporting by David Morgan; Editing by Caren Bohan and Tomasz
Janowski)
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