Sebelius to mayors: Urge your states to accept Medicaid expansion

Health and Human Services (HHS) Secretary Kathleen Sebelius urged U.S. mayors on Wednesday to push their state legislatures to expand Medicaid under ObamaCare.

Speaking to a room of about 25 mayors at the Winter Meeting of the U.S. Conference of Mayors, Sebelius said those in attendance were the “the pragmatic CEOs” that could help tip the balance in states that have so far refused to expand Medicaid under the Affordable Care Act by making their community's case for expanded coverage to state legislators.

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“I’d like to start this conversation by taking a pragmatic look — this is the law and there are benefits people are entitled to under the law, and also an opportunity to expand Medicaid under the law,” Sebelius said. 

“I think that your role is in helping to educate the residents of your community that they might be eligible for the first time to obtain healthcare, but also to have a very significant voice in the Medicaid debate taking place in your legislature is critically important,” she continued.

Sebelius said that so far 30 states — 10 of them run by Republican governors — have either accepted the Medicaid expansion under ObamaCare outright or worked with the administration to design an expansion that caters to a particular state's specific needs.

Still, the secretary acknowledged the issue was “complicated.” 

Republican governors and legislators argue that the policy will ultimately drain state coffers by increasing Medicaid rolls, and fear that the federal government won’t keep its funding promise, leaving them on the hook.

It’s also politically a fraught issue for some Democrats in an election year. Some don’t want to risk showing too much support for the unpopular healthcare law, but would have a hard time explaining to voters why they would decline federal funds for their constituents.

On Wednesday, Lucie Tondreau, the mayor of North Miami, Fla., asked Sebelius what she could do to help her poorest constituents gain healthcare coverage. The secretary singled out Florida as a state that could be ripe for persuasion on Medicaid expansion. 

Sebelius said that Florida’s uninsured rate is at 23 percent — the second highest in the country — and that about half of those would be eligible for Medicaid under the expansion, which would pump $51 billion in federal largesse into the Sunshine State over the next decade.

Florida’s Republican Gov. Rick Scott initially supported the Medicaid expansion, but reversed course when he announced in December that he was running for reelection. The expansion has failed once in the Florida state house but the legislature plans to reconsider. 

Sebelius on Wednesday laid out the administration’s argument for expansion to the mayors, saying that it’s “100 percent paid for” by the federal government in the first year, and that the most states will pay in future years is 10 percent. States can also participate for the first year and then withdraw. 

She called it the “single most generous federal-state partnership I’ve ever seen,” and argued that it doesn’t add to the deficit or the debt because the funds have already been allocated.

Republicans dispute that notion. 

“There is no such thing as free money,” Texas Gov. Rick Perry (R) said last year. “We know there’s only money that’s collected from taxpayers, and money borrowed from other countries like China against the good credit of our children and grandchildren.”

Sebelius’s comments on Wednesday coincided with an HHS release saying that the number of people determined eligible for low-income health insurance programs grew in December.

More than 6.3 million people were determined eligible for either Medicaid or the Children's Health Insurance Program (CHIP) between October and December, the HHS said. About 2.3 million of those came in December, during the administration’s enrollment push before the first open enrollment deadline.

Not all of the 6.3 million were deemed eligible solely because of the expansion. The administration has been criticized for not providing a breakdown of those who are eligible because of the expansion and those who would’ve been eligible anyway.