Voters in some states are heading to the ballot box this fall to deal with Obamacare, which they still see as a troubling issue.
Or at least part of it.
The decision by states whether to extend their Medicaid coverage to low-income, able-bodied people under Obamacare has put the topic back on the ballot across the South.
In looming gubernatorial contests, voters are debating whether Louisiana and Kentucky should stay the course and in Mississippi whether they should join the Medicaid expansion club.
Of the three, Mississippi presents the most clear-cut choice to voters.
Republican Gov. Phil Bryant, who is term-limited, has rebuffed all attempts to expand Medicaid under the terms laid out by the Affordable Care Act. Under those terms, states could expand Medicaid eligibility to people whose incomes were 138% of the poverty level, with the federal government at first paying the entire cost. In 2020, states will have to pay 10%.
In the race to succeed him, Republican Lt. Gov. Tate Reeves has been unwavering in his position that an expansion represents a potential catastrophe for taxpayers, while his opponent, Democratic Attorney General Jim Hood, says he would expand Medicaid.
“I believe that Obamacare expansion is wrong philosophically and that it is bad policy,” Mr. Reeves told The Washington Times. “Jim Hood would take us down the same liberal path as national Democrats. Their only solution is more government and more welfare. I believe we need a conservative approach that incentivizes more employer coverage and economic growth.”
Mr. Hood, on the other hand, has stressed the expansion of Medicaid as an “economic development opportunity” as well as an important issue for the state’s largely rural population.
“Health care is a major issue for people all over the state, being in the Delta, in the hills, on the coast, in south and west Mississippi and in Jackson,” he told The Washington Times. “When you put $1 billion in the economy, it has a huge impact. There’s no reason not to expand Medicaid, other than partisan politics.
“We had an emergency room in my hometown of Houston, Mississippi, my whole life, and now that emergency room is closed,” he said. “In 1940, we had better emergency health care in rural Mississippi than we have right now. That’s insane.”
Mr. Hood sees Medicaid expansion as something of a wash between the job opportunities it would open and the costs it would impose, so in the end, he argued, “it won’t cost the taxpayers any money.”
Mississippi is one of 14 states that has opted out of the expansion, which the Supreme Court made optional in its ruling upholding Obamacare as a tax. Medicaid spending in the state climbed more than 20% between 2012 and 2016, but appears to have leveled off since then. Indeed, the state’s Medicaid division reported spending $6 billion in fiscal 2017 and $5.85 billion in fiscal 2018.
Some 176,0000 Mississippians don’t have health insurance, according to the Kaiser Family Foundation. Of that total, 13,000 appear to be eligible under current guidelines but have not enrolled in Medicaid, while another 103,000 would become eligible if the state decided to expand the program.
The Reeves campaign points to neighboring Louisiana as a case study. In the Pelican State, Democratic Gov. John Bel Edwards used an executive order to expand Medicaid under Obamacare in July 2016.
As he seeks a second term, Mr. Edwards has touted the expansion as his signature accomplishment, saying it has saved lives, and his campaign frequently features residents who say they would likely be dead today if not for the expansion.
Yet the expansion has been bedeviled by questions of eligibility and cost. The state’s legislative auditor in November 2018 estimated as much as $85 million had been spent on health care for people who made more than they should to qualify for the benefit.
The administration acknowledged in February, when Medicaid rolls topped half a million people, that Louisiana’s growth rate had “unexpectedly” soared at a 7.5% clip.
“We just thought that expansion would be at a much slower growth than it is right now,” Pam Diez told a Medicaid forecasting panel, attributing most of the increase to residents in the New Orleans area.
Since the 2016 expansion, Louisiana Medicaid has cost taxpayers nearly 40% more, with the combined state and federal bill rising to $11.6 billion in fiscal 2018 from $8.3 billion in fiscal 2016. Currently, Medicaid covers 1.6 million people in Louisiana, or about 28% of the state’s population.
Republican Rep. Ralph Abraham, one of two GOP candidates vying to replace Mr. Edwards in an election where early voting began Saturday, has hit hard at Mr. Edwards’ stewardship of the Department of Health, but when he was asked directly whether he would roll back the Medicaid expansion, he said no.
Mr. Abraham’s announcement that he would keep the status quo, which was echoed seconds later by Baton Rouge businessman Eddie Rispone, the other Republican challenger, stunned Louisiana conservatives who said the responses squeezed their options.
“You start to get the impression that neither one is actually all that bothered by Edwards as Louisiana’s governor,” wrote Scott McKay, editor of the Hayride, a conservative site. “You’re conceding his ‘signature achievement’ as governor, an orgy of waste and fraud which is certain to bankrupt the state.”
The Rispone, Abraham and Edwards campaigns did not respond to questions about their position on Medicaid expansion.
Kentucky presents the most complicated picture of the three states in terms of what voters confront in November.
Its Medicaid rolls have doubled since Obamacare was introduced in 2013, with combined federal and state Medicaid spending of $9.66 billion in fiscal 2017.
Incumbent Republican Gov. Matt Bevin, who campaigned against the expansion by predecessor Gov. Steve Beshear, a Democrat, has not rescinded the 2014 executive order that expanded Medicaid in the state. Since the expansion, the percentage of uninsured Kentuckians has fallen from 20% to 8%, supporters said.
Instead, Mr. Bevin added requirements to Medicaid recipients — such as copays and premiums, along with 20 hours a week of community service — that have been tied up with legal challenges.
His opponent, Mr. Beshear’s son, Kentucky Attorney General Andy Beshear, would strip away any of Mr. Bevin’s proposed requirements, which he labeled “callous,” and continue the Bluegrass State’s expansion.
“Matt Bevin and out-of-state politicians and interest groups are threatening to tear away coverage and attempting to turn the clock back to a time when we had to pay more for worse care,” the Beshear campaign says.