The Never-Ending Story: States Continue, Reopen Medicaid Expansion Debate

Neither the proponents nor the opponents of Medicaid expansion are ready to concede defeat, even in some places we might have thought the issue was settled.

Possible Referendum in Arkansas

In Arkansas, the federal government had looked favorably on a privatized expansion program passed by the legislature, under which the federal funds would be used to buy private insurance for the people who became eligible for Medicaid because of the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148). The program was praised as an example of federal flexibility and state initiative. But an organization calling itself Arkansans Against Big Government presented  a proposal for a referendum to let the voters decide whether Arkansas should repeal the legislation authorizing the Medicaid expansion. The state Attorney General, Dustin McDaniel, approved the text and title on June 12, 2013. With that accomplished, the group must obtain the signatures of nearly 47,000 registered voters to have the referendum placed on the ballot. And the vote would occur in November 2014.  Meanwhile, state officials must establish that the program will be cost-effective and offer services equivalent to Medicaid in order to obtain federal approval.

Still Debating

The debate continues in Ohio, where Republican Governor John Kasich has supported Medicaid expansion, but the both the House and Senate removed it from the state’s budget proposals. A bipartisan group is working to pass an expansion bill outside the budget. Governor Kasich says that it would take six months to be prepared for the January 1 effective date, so time is running out.

In Michigan, Republican Governor  Rick Snyder has been pushing for expansion but has faced resistance from other Republicans. On Wednesday, June 12, 2013, a House committee voted 9 to 5 to send the bill to the full House. A House vote is expected to be held shortly.

Three states failed to pass expansion legislation during their regular sessions, but officials are considering bringing the legislature back for a special session. They include Florida, Mississippi, and Montana.  Governor Paul LePage of Maine vetoed a bill in May. The legislature passed another bill on June 12, 2013, but did not have the votes required to override a veto.

Recent Successes

In Arizona, Republican Governor Jan Brewer  declared her intent to expand Medicaid in January 2013. The governor had gotten the expansion legislation passed in the state Senate, but the House Budget Committee “failed” the bill on June 11th. Although the regular session had not been adjourned, Governor Brewer called a simultaneous special session of the legislature to hammer out a budget that includes Medicaid expansion.   House members debated through the night on Wednesday, June 12.  At about 3:40 a.m. on June 13, 2013, the House vote was complete. The Medicaid expansion was passed as part of the state’s $8.8 billion budget.

Iowa’s Republican Governor Terry Branstad opposed Medicaid expansion quite vocally in the days following the Supreme Court’s decision in National Federation of Independent Businesses v Sebelius, which made the expansion optional. But in May 2013, the legislature passed and the governor signed the Iowa Health and Wellness Plan, a broader program than Branstad proposed. Since then, state Medicaid director Jennifer Vermeer has been conferring with federal officials, and she says they have been receptive to compromise. Iowans with incomes at or below 100 percent of the federal poverty level (FPL) would receive a new, comprehensive package of public benefits similar to those available to federal employees.  Individuals with incomes between 100 percent and 138 percent of FPL would choose a commercial plan through the health insurance exchange. There would be no premiums charged and virtually no copayments for the first year. Thereafter, individuals who complete certain wellness activities, including obtaining preventive services, would pay no premium. Those who do not, and whose incomes exceed 50 percent of FPL, would contribute to the cost of their coverage.