- The Washington Times - Thursday, January 9, 2014

With Obamacare now in effect across the country, some Republican-led states will revisit their decisions to reject an expansion of Medicaid, once again deciding whether their contempt for the Affordable Care Act outweighs the allure of additional federal money in the short term.

But this year’s debate is different in a key respect: Governors and lawmakers now see how the expansion is playing out in other states.

The expansion took effect in 25 states and the District of Columbia last week, and cross-border envy is a major talking point among editorial writers and governors who haven’t given up on expansion.

Missouri Gov. Jay Nixon, a Democrat, marked New Year’s Eve by calling on Republican state legislators who rebuffed Obamacare to reconsider.

“Tomorrow, roughly $37 billion — including 2 billion of Missourians’ tax dollars — will begin to flow to 25 states that are reforming and improving their health care systems,” he said. “States like Arkansas and New Jersey, Iowa and New Mexico, Michigan and Ohio, Arizona and North Dakota.”

In New Hampshire, state Rep. Cindy Rosenwald, a Democrat, made a similar pitch in an op-ed that said Medicaid expansion should be the legislature’s top priority when it returns to Concord this week.

“This is tax money we already send to Washington, only now it will be returned to New Hampshire,” she wrote in the Nashua Telegraph.

The Affordable Care Act, as written by Congress, included generous terms for states that expand their Medicaid rolls to include those making up to 138 percent of the federal poverty level. But lawmakers also said states that didn’t expand their rolls would lose most Medicaid funding.

The Supreme Court struck down that latter provision, saying the government couldn’t force an all-or-nothing choice on the states, a decision that effectively left it up to each state whether to accept the expansion.

States had to declare last year whether they would expand Medicaid, which spawned battles between the two major political parties and among Republicans, but in states that refused, some lawmakers have promised to try again.

This year, “it’s safe to say Medicaid will be an issue in many states,” said Melissa Hansen, a program principal at the National Conference of State Legislatures.

Republican governors such as Jan Brewer in Arizona, John Kasich in Ohio and Chris Christie in New Jersey, have moved forward with Mr. Obama’s expansion after deciding it was a good deal for their states.

Supporters of Mr. Obama’s reforms say the expansion is a no-brainer that injects money into state economies and offers a compassionate lifeline to the poorest Americans.

It also prevents an odd coverage gap for as many as 5 million Americans, according to Kaiser Family Foundation estimates. These people earn too much for Medicaid but too little to qualify for subsidized private plans on state-based health care exchanges.

The federal government is paying 100 percent of the costs of expansion, but opponents doubt it will live up to its commitment to states by 2020, when the federal share is scaled back to 90 percent.

Detractors received new ammunition last week in the form of a study from Oregon that suggests Medicaid beneficiaries tend to visit emergency rooms more often — not less, as health care reform proponents have suggested.

Republicans looking for a compromise may be swayed by reform models in states like Arkansas, which is leveraging the federal dollars to purchase private coverage for those who are newly eligible, rather than expanding traditional Medicaid coverage.

Tennessee Gov. Bill Haslam, a Republican, put forth a Tennessee Plan that would use available federal dollars to buy private coverage for the expanded population.

But “because Medicaid programs differ from state to state,” his spokeswoman Alexia Poe said, “what we’re trying to do here, looks different than Arkansas, Iowa, etc.”

Pennsylvania Gov. Tom Corbett, a Republican, put forward his Healthy Pennsylvania plan in September to revamp Medicaid, which eats up nearly a third of the state’s general fund each year, governor’s spokeswoman Christine Cronkright said.

Among the plan’s mandates is a requirement for working-age beneficiaries to seek employment. The overall plan is being vetted in hearings this month.

“We’ve certainly looked at what other states have done and learned from that,” Ms. Cronkright said, “but we also saw the need to provide a uniquely Pennsylvania solution that would help us to increase access to quality, affordable healthcare while also finding ways to safeguard our Medicaid program for those who rely upon it well into the future.”

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