In a switch, GOP governors back expanding Medicaid

Once largely united in resisting the Obama administration's new health care overhaul, a growing number of Republican governors are now buying into parts of the system as the financial realities of their states' medical costs begin to counterbalance the fierce election politics of the issue.
Associated Press
Feb 9, 2013

This week, Michigan's Rick Snyder became the sixth GOP governor to propose expanding his state's health insurance program to cover more low-income residents, in line with the Democratic administration's strong recommendation. Eleven Republican governors have rejected the idea while a dozen, who have been mostly critical, have not announced a decision.

Although the Democratic president's re-election last fall cleared the way for providing health insurance for millions of Americans who don't have it, many Republican governors have resisted parts of the plan that remained optional. They have been reluctant to expand their Medicaid programs to cover more low-income residents. And many declined to take responsibility for the online marketplaces — called exchanges— that would offer subsidized private coverage to the middle class.

Both would pose costs to the states and also involved cooperating with a larger government role in health care that many Republicans strongly opposed.

However, the federal government's agreement to pay most of the added Medicaid expense, and belief that fewer residents would be showing up at local hospitals without insurance, have begun to break down some governors' opposition.

"Politically, the dynamic may be shifting," said Matt Benson, a senior aide to Arizona Republican Gov. Jan Brewer, who proposed expanding Medicaid last month. "There may be some folks looking at this anew."

Two high-profile Republican governors, Scott Walker of Wisconsin and Rick Scott of Florida, have voiced skepticism about the federal terms but are still considering the option.

Most Democratic governors have supported expanding their Medicaid programs to cover more low-income residents, mainly adults with no children at home, who don't qualify now. With such an expansion, Medicaid would account for almost all of the state's poor. Under the new federal plan, higher earners would be required to get private insurance. Together, the provisions are aimed at sharply reducing the 15% of Americans who are uninsured.

But many Republican governors shrank from taking on any further costs for Medicaid, which has heavily burdened state budgets. The federal government would pay the full cost for the first three years under the new system, but the states would pay up to 10 percent later. Some governors worried that the federal government could decide to trim back its contribution in the future.

The governors now agreeing to opt in and expand Medicaid include Republicans from different regions of the country and different ideological leanings. This has prompted hope among some health care overhaul supporters of more GOP defections. In addition to Snyder and Brewer, Republican governors who support expanding Medicaid include Jack Dalrymple of North Dakota, John Kasich of Ohio, Brian Sandoval of Nevada and Susana Martinez of New Mexico.

In each state, the proposal must still be approved by the legislature, where there is still Republican opposition.

Snyder said that in Michigan, the expansion would provide coverage for about 500,000 uninsured residents, mostly at federal expense, and save state taxpayers $1.2 billion through 2020. Many states now help hospitals cover some of the cost of treating those without insurance.

"This is a federal program that we would not have necessarily created for Michigan," he said Wednesday, but "this is saving money and improving lives."

Governors have been under immense pressure to opt in from hospital and medical associations, as well as advocates for the poor.

In explaining their decisions, Kasich, Brewer and others have said rejecting an expansion would mean their taxpayers would subsidize care for those in other states, while receiving no benefits themselves. In Ohio, that would be an estimated $2.4 billion over two years, Kasich said Monday.

"Ohio taxpayer dollars are coming back to Ohio to support a significant need we have," he said.

But governors elsewhere said they fear the states would be saddled with huge costs if the federal government later reneged on its commitment.

"The federal government, because of their budget problems, starts cutting back and...then you've just bought into something of a lead sinker," said Iowa Gov. Terry Branstad, among the skeptics. He has asked federal officials to allow his state to craft its own plan for low-income residents.

Virginia Gov. Bob McDonnell has also questioned the terms, saying he didn't "believe the federal government can possibly deliver its commitment to fully fund the program."

About half the states are preparing to participate in another part of the federal health plan —setting up an online marketplace, either by themselves or in partnership with Washington, where middle-class residents can shop for subsidized private insurance.  This group includes a half dozen GOP-governed states. Under the new system, the federal government will set up the online marketplaces, or exchanges, for states that decline to do so.  The new exchanges are scheduled to go into operation in October, with insurance coverage beginning in January 2014.



The Big Dog's back

Yeah, I'd much rather the rich have that money than using it for Healthcare. After all, we all have seen how well that's worked out.


@ Dog aka betrump:

Huh. Looks like Bernanke just sent billions to the European banks last month.

Call Pres. BHO and ask him where the "rich" are.


money that they have earned right dawg.

There you go again

Hey,folks, Obama has pushed states into going this route. He learned to do that from his Chicago mob-style tactics. Nothing new here.

John Harville

I wondered how long it would be until Chicago-style came in to play.
Why not Boss Tweed, Tammany Hall....


@ John Harville:

Good call! Tweed was another corrupt Democrat. :)

John Harville

Ya know. There's a reason I come to these blogs. It's the only place I can find so much concentrated ignorance (unwillingness to ponder facts), dislike for the less fortunate, outright hate, complaining with out offering alternatives, bitter hatred and namecalling of the President, gross misinformation about the Constitution and founding of this country and... oh well.




John Harville writes:

"...outright hate, complaining with out offering alternatives, bitter hatred and namecalling of the President,"

"You must love him (Big Brother). It is not enough to obey him. You must love him." - Nineteen Eighty-Four.


With the exception of calling Barry Soetero Obozo, you pretty much nailed all your postings. John Harville

John Harville

"WE make a living by what we get; we make a life by what we give."

C'mon yall. Now it's time to attack Winston Churchill.


@ John Harville:

Didn't Pres. BHO send the bust of WC back to England?

Believe that BO, Sr. hated the British right? "Dreams from My Father"?


Just more of your hard earned money going to government programs. Doesn't matter if you are rich, semi rich...etc. Your money is your money.....or at least should be that way.


"When the president does it that means it's not illegal."


Our federally-elected officials wanting to have health care available to all citizens of the United States was a noble cause. And as much as I applauded Obama for pushing to get National Health Care passed into law, it was unbelievably frustrating to see the single-payer option *NOT* adopted.

Additionally, even though the Congressional Budget Office (CBO) did a good job in determining that the ACA "should" save money, I italicized "should" because there's one variable they and nobody else can ever correctly model: how the medical insurance companies will work to insure their profit gravy train keeps on chugging along. The authors of the ACA must have been paid extremely well by medical insurance lobbyists as the Act is devoid of any curbs on insurance companies being able to raise costs, as this NY Times article clearly, and painfully, points out: This is all simple economics in action. The insurance companies have no competition. Medical insurance is almost a perfect example of the inelastic demand model, where the supply and demand is unaffected by the change in price.

As many have pointed out, just about the only way we can get our federally-elected officials to start truly representing their constituents is when we get them dipping out of the same trough as we are when it comes to medical insurance or retirement benefits (i.e. Social Security), to name two items. As long as our President, House and Senate don't feel the same pain as those they supposedly long as they continue to have no long as they are bank-rolled by lobbyists..."We the People" will continue to be met by deaf ears and blind eyes.