Obama speech kicks off new drive to ex­pand Med­i­caid

Modern Healthcare - - NEWS - By Beth Kutscher

NASHVILLE—With the Af­ford­able Care Act’s pre­mium sub­si­dies pro­tected for now, the Obama ad­min­is­tra­tion and the hos­pi­tal in­dus­try are step­ping up their ef­forts to per­suade the 21 hold­out states to ex­pand Med­i­caid to low­in­come adults.

Pres­i­dent Barack Obama spoke last week in the cap­i­tal of Ten­nessee, a state where Repub­li­can Gov. Bill Haslam re­cently was blocked by the GOP-con­trolled Leg­is­la­ture in his ef­fort to es­tab­lish a con­ser­va­tive­friendly ver­sion of Med­i­caid ex­pan­sion. Last month’s U.S. Supreme Court de­ci­sion in King v. Bur­well pre­served sub­si­dies for 156,000 Ten­nesseans.

An ob­vi­ously up­beat Obama talked about push­ing ahead with healthcare re­form. “One thing I’m hop­ing is that with the Supreme Court case now be­hind us, we can fo­cus on how to make it bet­ter,” Obama said dur­ing his speech at Nashville’s Tay­lor Strat­ton Ele­men­tary School, which was at­tended by a who’s who of healthcare lead­ers. “There are still ar­eas of im­prove­ment and there are still peo­ple who are unin­sured.”

Since the rul­ing, Demo­cratic gover­nors in Alaska, Mis­souri and Vir­ginia have in­di­cated they want to re­open dis­cus­sions about ex­pand­ing Med­i­caid, as has Haslam. Mean­while, Repub­li­can-led Utah is in talks with the ad­min­is­tra­tion about an ex­pan­sion model. Sup­port­ers hope the King rul­ing will give their cause mo­men­tum. But op­po­si­tion to the ACA and Med­i­caid ex­pan­sion re­mains pow­er­ful among Repub­li­cans, fu­eled by fiery an­tiOba­macare cam­paign state­ments from pres­i­den­tial hope­fuls, in­clud­ing the gover­nors of Louisiana and Wis­con­sin.

Obama men­tioned Med­i­caid ex­pan­sion only obliquely in his pre­pared re­marks. But pressed by an au­di­ence mem­ber, the pres­i­dent said states that have ex­panded Med­i­caid have re­duced their unin­sured rate more quickly than other states. “Here in Ten­nessee, that’s prob­a­bly a cou­ple hun­dred thou­sand peo­ple who could ben­e­fit,” he said. “Given the strong history of in­no­va­tion of healthcare in Ten­nessee ... you all should be able to find a so­lu­tion. The fed­eral gov­ern­ment is … ready to work with the states that want to get go­ing.”

Con­ver­sa­tions are start­ing among GOP state pol­i­cy­mak­ers about whether to now ex­pand Med­i­caid, said Tr­ish Ri­ley, ex­ec­u­tive di­rec­tor of the Na­tional Academy for State Health Pol­icy, which will host a sum­mit July 9 on the is­sue. “The ques­tion is whether the pol­i­tics change,” she said.

States may be more com­fort­able ex­pand­ing Med­i­caid with stronger bud­gets and an im­proved econ­omy, said Joseph An­tos, who fo­cuses on healthcare at the con­ser­va­tive Amer­i­can En­ter­prise In­sti­tute. Still, he ar­gued that HHS needs to be more flex­i­ble in work­ing with GOP-led states, some of which are seek­ing to im­pose work re­quire­ments, pre­mium con­tri­bu­tions and other per­sonal- re­spon­si­bil­ity rules for new ben­e­fi­cia­ries. “Un­til HHS gives a sig­nal to the states that they’re ac­tu­ally open to new ideas, I don’t think we’ll see more states jump on this,” An­tos said.

But Bri­etta Clark, a pro­fes­sor at Loy­ola Law School in Los An­ge­les, said HHS is lim­ited in what it can ap­prove. “The ad­min­is­tra­tion has been re­ally open and flex­i­ble with work­ing with the states,” she said. “It’s the Af­ford­able Care Act that put clear con­straints on what the states can do.” For ex­am­ple, some Repub­li­cans have pro­posed ex­pand­ing el­i­gi­bil­ity only to peo­ple up to 100% of the fed­eral poverty level, but the ACA sets the thresh­old at 138%.

In Ten­nessee, the po­lit­i­cal winds may be shift­ing since the Leg­is­la­ture shot down Haslam’s In­sure Ten­nessee pro­posal this year. That plan would pro­vide vouch­ers for Med­i­caid el­i­gi­ble peo­ple in the Med­i­caid cov­er­age gap to pur­chase pri­vate cov­er­age. It would re­quire hos­pi­tals to pick up an in­creas­ing share of ex­pan­sion costs when fed­eral match dol­lars drop from 100% to 90% af­ter 2016.

In Nashville—the cen­ter of the coun­try’s for-profit healthcare in­dus­try—the fight for Med­i­caid ex­pan­sion has been par­tic­u­larly con­tentious. That’s be­cause hos­pi­tal and healthcare com­pa­nies such as HCA have sup­ported the ACA’s Med­i­caid and pri­vate-in­sur­ance ex­pan­sions, given that they of­fer mil­lions of Amer­i­cans a way to pay their med­i­cal bills.

Dur­ing his re­marks, Obama thanked for­mer Se­nate Ma­jor­ity Leader Bill Frist, a Ten­nessee Repub­li­can who has been sup­port­ive of the ACA. The King rul­ing “al­lows an op­por­tu­nity for Ten­nesseans to be fur­ther ed­u­cated about the ben­e­fits of Med­i­caid ex­pan­sion,” Frist said in an in­ter­view af­ter the pres­i­dent’s re­marks. “Mo­men­tum is mov­ing in that di­rec­tion, but it will re­quire bi­par­ti­san and non­par­ti­san sup­port to get there.”

“I hope this rul­ing will en­cour­age state gov­ern­ments that the in­tent of Congress has to be val­i­dated and they’ll ex­pand their Med­i­caid pro­grams,” said Bill Car­pen­ter, CEO of Brent­wood, Tenn.-based LifePoint Health, who also at­tended the speech.

At the pres­i­den­tial speech, the Ten­nessee Jus­tice Cen­ter ral­lied a group of sup­port­ers wear­ing pur­ple “In­sure Ten­nessee Now!” T-shirts. “Peo­ple fi­nally un­der­stand who it will help,” said Michele John­son, the cen­ter’s ex­ec­u­tive di­rec­tor. “We are ab­so­lutely over­whelmed with hope that this thing is go­ing to pass.”

Pres­i­dent Barack Obama ral­lied speech at­ten­dees to seek cov­er­age ex­ten­tion.

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