One of the biggest losers in the midterm elections was Medicaid expansion.
This year, a handful of Republican governors --who previously opposed expanding their Medicaid programs--won re-election. This was bad news for the Obama Administration, which has tirelessly attempted to persuade states to expand their programs, either through Medicaid expansion under the Affordable Care Act, or other alternatives.
“Because Medicaid spurs progress in all 50 states, we want to bring Medicaid expansion to all 50 states, and we are eager to work with any and all states in partnership to make this happen,” Health and Human Services Secretary Sylvia Burwell said in a statement earlier this month.
But the GOP governors’ victories are likely to set back the administration’s efforts to move states toward expansion, which for the first time offers Medicaid to able-bodied single men and women.
The program expands Medicaid coverage to residents with incomes at or below 138 percent of the federal poverty level or $15,856 for an individual and $32,499 for a family of four. It’s fully paid for by the federal government for the first three years, then at 90 percent after that.
The governors that have opted out of expansion, however, say the program isn’t financially sustainable for their state in the years ahead. Opponents also note that covering childless adults would ultimately mean reducing services to indigent families who rely on the traditional Medicaid program.
Originally, states were required to expand their Medicaid programs under the Affordable Care Act. But in 2012, the Supreme Court ruled that states should have a choice in whether to be a part of the expansion. So far, 23 states and the District of Columbia have expanded their programs. Another four states have an alternative expansion program that includes federal waivers given to individuals to purchase their own coverage in the private market.
But in the states where there have been no efforts to expand coverage through Medicaid, some 5 million people have fallen into a so-called coverage gap—where people are too poor to receive federal subsidies for the health exchanges, but who do not qualify for the states’ existing Medicaid programs either.
The New York Times noted ahead of the elections that if a Republican governor in one of the six hotly contested races was replaced by a Democrat or Independent in these states, it could mean “as many as 1.3 million more people will get health coverage in the years ahead.”
Of course, that didn’t happen. Not even close. Republicans swept the midterms, especially where Medicaid expansion was uncertain.
Incumbent GOP governors who opposed expansion were re-elected in Georgia, Kansas, Maine and Wisconsin. According to Kaiser, about 409,000 people are trapped in the coverage gap in Georgia, about 78,000 people in Kansas and about 24,000 people in Maine. There are no accurate figures for Wisconsin yet, but it’s expected to be in the tens of thousands as well.
Meanwhile, the midterm election results for Arkansas’ state legislature have jeopardized the state’s alternative Medicaid expansion program, which has served as a model for other states looking to expand their programs without relying on the ACA’s traditional expansion.
Arkansas’ term-limited Democrat governor is being replaced with Republican Gov. Asa Hutchinson who hasn’t specified whether he will continue the program or not.
Arkansas’ so-called private option uses federal money to buy policies for low-income people on the private exchange. The program has already proved to be more expensive than anticipated.
The Government Accountability Office said the program was costing about $778 million more than traditional Medicaid expansion. With a GOP-controlled state legislature that might seek its repeal -- and without an enthusiastic governor backing it like outgoing Gov. Mike Beebe -- it may be eliminated. Right now, some 200,000 Arkansans are enrolled in the program. If the state does scrap the program, those people will be without coverage.
What’s happening in Arkansas could have an impact on other states that are either already implementing a similar private option or are considering setting up their own Medicaid expansion alternatives. Regardless, it’s not likely that traditional Medicaid expansion under the ACA will move forward in any new states…for now.
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