- The Washington Times - Wednesday, August 28, 2013

Some of the Republican-led states holding out against expanding their Medicaid programs are beginning to cave, effectively embracing a key pillar of President Obama’s health care law.

Michigan Gov. Rick Snyder, a Republican, persuaded enough lawmakers in his party this week to accept his plan to extend Medicaid to more low-income residents.

Expanding the federal-state health program to those making up to 138 percent of the federal poverty level is one of two major provisions in the Affordable Care Act that will take effect in the coming months, alongside private-insurance “exchanges” where Americans without employer-based insurance can buy coverage with the help of government subsidies.

The Michigan House is expected to approve Mr. Snyder’s measure — it requires beneficiaries to cover co-payments, among other conditions — placing him among Republican leaders who overcame near-blanket opposition to the health care law within the party.

In conservative Wyoming, lawmakers this week began to consider a “private option” that would allow the extra Medicaid beneficiaries to buy insurance on the state’s health exchange, using the federal money to subsidize the plans.

The method was pioneered in Arkansas, where state officials have requested a waiver from the federal government to implement the plan.

Wyoming state Rep. Elaine Harvey, a Republican who is chairwoman of the Legislature’s health committee, said her state has misgivings about the health care law, particularly since its low population could make its health exchange unviable.

But, she said, the state’s political dynamic is “so not Washington, D.C.,” and the Arkansas-inspired plan seemed like an intriguing way to add members to the exchange.

“Now it’s the law of the land, so what are we going to do?” she said.

Former President Bill Clinton will visit Little Rock, Ark., on Wednesday to promote the law, offering Mr. Obama’s key legacy item a high-profile boost in the state that pioneered trying to make the Medicaid expansion palatable for Republican lawmakers.

The multistate push comes as conservatives such as Sen. Ted Cruz, Texas Republican, call on fellow lawmakers to defund Obamacare altogether next month as part of a spending showdown on Capitol Hill.

Mr. Cruz and advocacy groups such as Heritage Action are fighting opposition to their strategy from senior Republicans, who say risking a government shutdown over the health care law is a bridge too far.

States embracing parts of Mr. Obama’s law could complicate the defunders’ efforts.

“If anything, it emphasizes the need for leadership from congressional Republicans,” Heritage Action spokesman Dan Holler said. “The absence of determined and concrete action from Congress to stop the law’s implementation sends a signal to those outside Washington — governors, state legislators and voters — that opposition to the law is merely rhetorical. Rhetorical opposition won’t improve the quality of health care and it won’t inspire voters.”

State-level battles over Medicaid can be traced to the Supreme Court’s decision last year to let states choose whether to expand the entitlement within their borders without risking existing federal funding for the program.

Under Mr. Obama’s law, the federal government will pay for 100 percent of the expanded population in 2014 to 2016 before scaling back its contribution to 90 percent in 2020 and beyond.

Republican support for the expansion has been elusive, since many conservatives see it as a betrayal of party values and affirmative support for Mr. Obama’s contentious overhaul, and they argue it creates an unsustainable burden on states in the long run.

But the influx of federal funds has enticed about half the states.

Twenty-four states and the District of Columbia have opted to expand their Medicaid programs in the coming year, while 21 have declined to expand, according to the Kaiser Family Foundation. Five states — Indiana, New Hampshire, Ohio, Pennsylvania and Tennessee — are still mulling their options.

Republican leaders in some of those states have said they would like more flexibility from the federal government in how they implement the Medicaid program.

• Tom Howell Jr. can be reached at thowell@washingtontimes.com.

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