State fights rage over ObamaCare’s Medicaid expansion

State fights rage over ObamaCare’s Medicaid expansion

The fight over ObamaCare’s Medicaid expansion is heating up, with one state mounting a fresh legal challenge against the administration and others embroiled in debates over how to handle the thorny issue.
In Florida, one of the biggest prizes for expansion advocates, a dispute between the state and the federal government intensified Thursday, when Republican Gov. Rick Scott announced that he would sue the administration over what he calls attempts to force participation.

In other states, notably Utah, Tennessee, and Wyoming, Republican governors in favor of expansion are trying to get their statehouses to go along with the program. The Koch brothers-backed group Americans for Prosperity has been running ads in districts of targeted members in different states to fight the expansion effort.


States have a choice as to whether to accept ObamaCare’s expansion of eligibility for Medicaid, the government health insurance program for low-income people. So far, 28 states, including 10 with Republican governors, have taken the expansion.
The Obama administration has tried to signal flexibility and a willingness to work with state-level Republicans on compromises to put conservative twists on the program if it is expanded.
But the White House took a sharper tone Thursday in reaction to the Florida lawsuit, noting that expansion could provide coverage for 800,000 people in the state.
“It's difficult to explain why somebody would think that their political situation and their political interest is somehow more important than the livelihood and health of 800,000 people that they were elected to lead,” White House Press Secretary Josh Earnest said.
There have been both successes and failures this year, as Republicans look to approaches that add conservative elements like premiums and job training to Medicaid.
Montana’s Republican legislature approved expansion this month, after Indiana did earlier in the year.
However, Utah’s Republican governor and legislature couldn’t reconcile competing plans by the end of the session last month. They are continuing to negotiate.    
In Tennessee, Republican Gov. Bill Haslam worked for months to build support for a plan, only to see it fail in the legislature in February.
Advocates are optimistic the states will eventually agree to terms, noting other efforts took years of pushing before ultimately succeeding.
“What you see in Tennessee is what you saw a couple of years ago in Montana,” said Patrick Willard, field director for the health advocacy group Families USA.
The expansion battles have set up splits between Republican governors and legislators in their party. 
“When you’re a governor and you see the big picture of the state’s finances, it makes more sense to be open to taking that money,” said Sean Foreman, a political scientist who tracks Medicaid expansion at Barry University in Florida.
The federal government initially pays the entire cost of expansion, then dials it back to 90 percent.
Marty Carpenter, a spokesman for Utah's Republican Gov. Gary Herbert, said Medicaid expansion is following a conservative principle because the state will be taxed under ObamaCare either way.
“By not expanding the Medicaid coverage we’re donating far more of those dollars to other states than we feel we should as a conservative state,” he said.
But Republican legislators often are still resistant.
Tennessee state Rep. Glen Casada (R), who helped lead the effort against expansion there, called it “a significant financial burden that we just can’t afford.”
“We like this governor, but on this one issue, he was wrong,” he added.
Research shows that expansion states have seen much larger drops in the uninsured rate. An Urban Institute study released this week found that the uninsured rate dropped by over 50 percent in expansion states since 2013, compared to 30 percent in non-expansion states.

Florida is at the center of the battle, as it is one of the largest states not to expand Medicaid.
Scott argues that the administration is trying to force his state to expand Medicaid by linking Medicaid expansion to separate federal funding to help hospitals in the state care for the uninsured, known as the Low Income Pool (LIP). Scott wants the LIP money, but does not want to expand Medicaid. 
“It is appalling that President Obama would cut off federal healthcare dollars to Florida in an effort to force our state further into ObamaCare,” Scott said in a statement.
The administration says that the LIP funding will not continue in its current form past June 30. It points out that the program was optional and temporary, and that providing people with coverage in the first place through Medicaid expansion is a better system than giving funds to hospitals to care for the uninsured.
But the administration says Florida is free to expand Medicaid or not, and that while Medicaid expansion is “linked” to the LIP funding, it is not entirely dependent on it.
Meanwhile, the legislature is at an impasse over expansion. The state Senate, led by Republicans, is in favor of it. The House, also controlled by Republicans, is against it. The chambers must agree on a budget, but the LIP and Medicaid funds are up in the air.
Pro-expansion Senate President Andy Gardiner (R) said in an interview that the sides are at a standstill, but the federal decision on how much, if any, LIP funding to give could spur the talks. “Everybody seems to be waiting on this magic number from CMS,” he said, referring to the federal Medicaid agency.
But he is critical of Scott for suing, saying the state has known for a year that LIP was expiring.

“It’s an intriguing situation to demand money for a voluntary program that nobody has to participate in,” he said.
“While everybody's pointing fingers at CMS and suing everybody we knew this was going to happen a year go,” he added.