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.

 

Comments

mikel

supporters of obamacare are going to slowly get a good glimpse of just what is in this bill. it is interesting to note that according to info just recently released by the irs that an employer only has to offer coverage to an employee under this plan. dependant coverage is not mandatory and an employer cannot be fined. employee contributions will be capped at 9.8%, i believe. so, how exactly is this insuring more people? if an employee has their family on a current plan and pays 20% of the premium this will not be allowed. thus, more employers in all probability will drop the dependant coverage from their plans. hmmmm

The Big Dog's back

The Repub boogeyman around every corner.

kal-el

The employee cap of 9.8% is the "affordable" part of the Affordable Care Act. Dependents are absolutely covered, up to age 26. More people will be insured under the new insurance exchanges that the act funds and will begin in '14 or '15. This is where high risk folks will be able to get insurance that currently can't get from private insurers.

We could have made this a lot less complicated by going the "Medicare for all" route like the rest of the civilized world. But asking Congress to act with common sense and simplicity is like asking a pig to fly.

mikel

which, according to many citizens of those countries, is not the best healthcare.

John Harville

MIKEL: Who please? I have friends and relatives in Canada, Great Britain, some South American countries. They all speak highly of their health care - including restrictions on doctors that assure extra procedures are actually needed and not just another way to make money. Emergency procedures are promptly treated. Meds a paid. Paid leave is a given...

Contango

@ John Harville:

So why did Canadians sue their healthcare system for access to care?

Being put on a waiting list and waiting months is not healthcare.

Tort reform would help lower costs in the U.S.

coasterfan

Like they did with Social Security and Medicare in earlier generations, Republicans have been all gloom and doom about Obamacare. As was case with SS and Medicare, ten years from now, it will be obvious that providing health care for all Americans was absolutely the right thing to do. Twenty-five years from now, we will look back at the people who opposed Obamacare in 2012 in the same way as we now view racists in the 1960's who spoke out against equal rights for minorities.

mikel

not even close to being the same thing. minorities fought for the same rights as everyone else. currently, EVERY person has the same right to have health insurance. no one is holding them back but themselves.

kal-el

Completely untrue, mikel. There are many Americans who cannot get health insurance in the current system.

mikel

there are many people who can't get homeowner and auto insurance as well. yet, our gov't doesn't provide for them. all health insurance companies must comply with an open enrollment period during which they must take a certain % of indivduals with health problems. people need to find that period and make sure that they apply. i know that is asking alot for some of those people to be responsible.

it is interesting that many people have no sympahty for someone who has had 5 dui's and can't get auot insurance. deserves him right they say. yet is a an issue for a health insurance company to reject a person who has smoked 4 packs of cigs per day and has cancer. or the person who drinks a 12 pack of pop per day and eats nothing but junk food and has diabetes. self inflicted health problems are the same as a self inflicted dui imo.

John Harville

Mikel 12;59 post... wow... you really DO believe all you say.

Owning a home or driving a car is not a right, but a privilege.
Living IS a right.
The government does have assistance programs for homeowners and auto owners (something else you missed?). Like the AHCA/Exchange program, the auto and home plans insurance has a graduating scale cost. In fact the homeowners program is state-financed.
I've never heard an open enrollment period for private insurance companies...although they ususally jump in during Medicare open enrollment to sell their supplemental plans. Please enlighten.
DUI vs tobacco? Drunk Drivers kill people - other, innocent people.
Only second-hand smoke kills other people.
Which brings up... Life Insurance should have an extra premium for gunowners.

mikel

Johnny, the state of Ohio has what they call the Ohio fair plan for homeowners who can't get insurance from a private carrier. The theory is that you can buy insurance through the state. They will do an inspection of your property and if it does not meet their standards they can deny you!! I know you won't believe me so call your agent and ask or better yet call Ohio dept. Of insurance.

John Harville

Moderators have removed this comment because it contained Personal attacks (including: name calling, presumption of guilt or guilt by association, insensitivity, or picking fights).

Fromthe419

Have you looked at our unfunded liabilities lately? Social Security/Medicaid/Medicare and Government pensions are estimated at 123 Trillion dollars. Just another ponzi scheme that will no doubt lead to the destruction of our nation and economy. 25 years from now Social Security and the other mentions and our interest on the national debt will eat 100 percent of the budget, there will be no money for other spending. I'm not making this stuff up, youtube search David Walker former head of the United States Comptroller General from 1998 to 2008. Listen to what he has to say and let me know if you feel the same way.

Nor'easter

Social Security was a totally funded program until Lyndon Johnson scammed the program and began "borrowing" from the Social Security Trust Fund to pay for his "New Deal" and in recent history Obama scammed us by reducing the payroll tax from 6.2% to 4.2% for the past 2 years and then claimed that Social Security was going broke. Funny how not collecting the tax for 2 years creates a negative cash flow. Figures don't lie, but liars figure how to defraud the citizens.

The Big Dog's back

The same amount of money was put into the S S fund. That 2% was made up with Federal tax dollars.

mikel

because the fed treasury is flush with cash right dawg?

John Harville

Actually, the Fed treasury has a great deal of money... and the 2% extra tax was passed by ... hate this don't you? ... Congress.

And if all the Americans who hold 60% of the National Debt would cash in their bonds, etc. we'd be even more flush.

Contango

John Harville writes:

"And if all the Americans who hold 60% of the National Debt would cash in their bonds, etc. we'd be even more flush."

Makes no sense.

The Treasury already has the money through the sale of the bonds, 50% which is held by foreigners.

John Harville

419 Social Security WAS well-funded by the mass of Baby Boomers paying the tax that supported our parents' pensions and built up a large trust fund. Medicare is paid by workers. Those only are entitlements in the sense that we are 'entitled' to a return on our insurance.
Social Security and Medicare ARE NOT IN THE BUDGET!!! Only the REPAYMENT to the Trust Funds should be in the budget - but isn't. So get off that particular HATE TRAIN. After Johnson, Reagan raped the trust fund to reduce his deficits.

kal-el

Well said, coaster. I mean, do the opponents of health coverage for all really realize what they're saying? Ironically, they are usually from the "pro life" crowd.

Contango

coasterfan writes:

"Twenty-five years from now, we will look back at the people who opposed Obamacare in 2012 in the same way as we now view racists in the 1960's who spoke out against equal rights for minorities."

So you're a big fan of fantasy huh?

I happen to be a student of History.

The USSR was the first country to constitutionally guarantee universal health care.

Their command and control economy ultimately collapsed due to waste, fraud and abuse.

Needless-to-say, the Progressives in this county think that they are smarter than those dumb ol' Russians - they ain't.

History doesn't repeat, but it rhymes.

John Harville

Moderators have removed this comment because it contained Personal attacks (including: name calling, presumption of guilt or guilt by association, insensitivity, or picking fights).

Contango

@ John Harville:

Solutions?

Much of what Dr. Ben Carson said at the NPB would be a good start.

http://www.examiner.com/article/...

KURTje

Hey; just take away their medical or let US get into what they have. Don't they "work" for US? eye roll

abigbear

DEATH PANELS make them get into bho plan

John Harville

abigboar... What. The other empty arguments aren't working so we dig up the 'Death Panels'? Or are you referring to the existing insurance companies which decide who does and doesn't get health care?

John Harville

I assume you mean Congress? Good idea.
Also remove the cap on SS tax at $110,000. Make them pay it on ALL their income- and make them report their offshore money.
And make them - and the wealthy - pay Medicare supplement OR don't allow them to use Medicare.

grumpy

Moderators have removed this comment because it contained Profane, obscene, sexual or derogatory language.

Contango

The fact is that Medicaid is one of the fastest growing items on state budgets.

http://www.huffingtonpost.com/20...

The U.S. govt. should take over the funding with more Fed produced funny money.

2008 - $10T Fed deficit

2012 - $16T Fed deficit

2016 - $20T Fed deficit

This won't end well.

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.

Contango

@ 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.

http://www.zerohedge.com/news/20...

mikel

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....

Contango

@ 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.

shucks

.

Contango

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.

goofus

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.

Contango

@ 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"?

http://www.telegraph.co.uk/news/...

arnmcrmn

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.

KURTje

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

OSUBuckeye59

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: http://www.nytimes.com/2013/01/0.... 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 represent...as long as they continue to have no accountability...as long as they are bank-rolled by lobbyists..."We the People" will continue to be met by deaf ears and blind eyes.