GOP gover­nors fight up­hill bat­tle to save Med­i­caid ex­pan­sion

Modern Healthcare - - NEWS - By Vir­gil Dick­son

An ef­fort by Repub­li­can gover­nors in Med­i­caid ex­pan­sion states to show the ex­pan­sion is worth keep­ing is un­likely to in­flu­ence con­gres­sional Repub­li­cans in their drive to re­peal the Af­ford­able Care Act and its ex­pan­sion of cov­er­age to low-in­come adults, Repub­li­can ex­perts say.

In­stead, con­gres­sional Repub­li­cans are ex­pected to push ahead to re­peal the Med­i­caid ex­pan­sion and con­vert Med­i­caid from an en­ti­tle­ment to a capped pro­gram of fed­eral con­tri­bu­tions to the states, said Jon Gil­more, a Repub­li­can strate­gist in Arkansas.

That would give state of­fi­cials far greater lee­way to set el­i­gi­bil­ity and ben­e­fit lev­els but likely would sharply re­duce fed­eral con­tri­bu­tions over time. Crit­ics say this type of block grant or per capita grant ap­proach would lead to states re­duc­ing en­roll­ment, trim­ming ben­e­fits and cut­ting pay­ments to providers. Democrats are ex­pected to strongly op­pose this ini­tia­tive.

But Med­i­caid ex­pan­sion ad­vo­cates hope the gover­nors’ lob­by­ing will cause con­gres­sional Repub­li­cans to think twice be­fore wip­ing out the cov­er­age ex­ten­sion that has brought bil­lions of fed­eral dol­lars into their states.

Last week, Ohio Gov. John Ka­sich said ex­pan­sion has been key to bat­tling opi­oid ad­dic­tion in his state, where about 700,000 peo­ple have gained Med­i­caid cov­er­age. “Thank God we ex­panded Med­i­caid be­cause that Med­i­caid money is help­ing to re­hab peo­ple,” Ka­sich said.

His ad­min­is­tra­tion re­cently re­leased sur­vey data show­ing 75% of the peo­ple who gained Med­i­caid cov­er­age were unin­sured be­fore be­com­ing el­i­gi­ble for Med­i­caid, and that more than 1 in 4 have been di­ag­nosed with at least one chronic con­di­tion. The re­port said ex­pand­ing Med­i­caid has re­duced emer­gency depart­ment use, im­proved self-re­ported health, and sup­ported em­ploy­ment and job-seek­ing.

“Let’s say (Congress) got rid of it and didn’t re­place it with any­thing. What hap­pens to those 700,000 peo­ple?” Ka­sich told re­porters Wed­nes­day. “What hap­pens to drug treat­ment? What hap­pens to men­tal health coun­sel­ing?”

Repub­li­can Michi­gan Gov. Rick Sny­der also has urged con­gres­sional Repub­li­cans to think twice about re­peal­ing it. The ex­pan­sion is pro­jected to cover 620,000 Michi­gan­ders by 2020. “I hope they care­fully look at the suc­cess we’ve had in Michi­gan,” Sny­der told the Detroit News. “We’re see­ing a huge in­crease in cov­er­age.”

Michi­gan gained than 30,000 jobs and $2.3 bil­lion in eco­nomic ben­e­fits since ex­pan­sion, ac­cord­ing to a new study from the Univer­sity of Michi­gan In­sti­tute for Health­care Pol­icy and In­no­va­tion.

In Arkansas, Repub­li­can Gov. Asa Hutchin­son last week said he asked the in­com­ing ad­min­is­tra­tion of Pres­i­den­t­elect Don­ald Trump to let states con­tinue to re­ceive en­hanced fed­eral fund­ing for ex­pan­sion. He also asked the Trump team to give states free­dom to set stricter el­i­gi­bil­ity stan­dards and im­pose new em­ploy­ment re­quire­ments.

In North Carolina, new Demo­cratic Gov. Roy Cooper an­nounced he’ll seek to ex­pand Med­i­caid in his state, though Repub­li­can leg­isla­tive lead­ers there say they will block that move.

De­spite these ef­forts by gover­nors, con­gres­sional Repub­li­cans seem de­ter­mined to roll back Med­i­caid ex­pan­sion, ar­gu­ing it’s un­af­ford­able for both the fed­eral govern­ment and the states. Un­der the ACA, the fed­eral govern­ment will pay 95% of the cost of ex­pand­ing Med­i­caid to adults with in­comes up to 138% of the fed­eral poverty level. That will phase down to 90% by 2020.

A pro­posal by Repub­li­can House Speaker Paul Ryan to re­peal and re­place the ACA would re­duce the fed­eral con­tri­bu­tion for the ex­pan­sion pop­u­la­tion to each state’s stan­dard fed­eral Med­i­caid match­ing rate, which would be closer to 60% on av­er­age. Many states likely would end their ex­pan­sions if they had to come up with the bil­lions of dol­lars to re­place the lost fed­eral fund­ing.

Med­i­caid spend­ing by the fed­eral and state gov­ern­ments rose 13.9% to $532 bil­lion in fis­cal 2015, the first full year of im­ple­men­ta­tion of ex­pan­sion, ac­cord­ing to the Kaiser Fam­ily Foun­da­tion. The ex­pan­sion is es­ti­mated to have added about 12 mil­lion low­in­come adults to the Med­i­caid rolls in the 31 states that have im­ple­mented the law’s ex­pan­sion.

“It’s not sus­tain­able to con­tinue the ex­ist­ing fed­eral match no mat­ter how much the gover­nors get­ting it are lik­ing it,” said Brad Todd, found­ing part­ner of On Mes­sage, a Repub­li­can me­dia strat­egy firm.

The non­par­ti­san Com­mit­tee for a Re­spon­si­ble Fed­eral Bud­get has es­ti­mated that end­ing Med­i­caid ex­pan­sion would save the govern­ment $1.1 tril­lion by 2027.

Among Democrats, how­ever, there is some op­ti­mism that ef­forts by Repub­li­can gover­nors to high­light the ben­e­fits of Med­i­caid ex­pan­sion could stall con­gres­sional re­peal ef­forts. Al­ready, some Repub­li­can sen­a­tors from ex­pan­sion states, such as Shel­ley Moore Capito in West Vir­ginia, have ex­pressed reser­va­tions about rolling back the cov­er­age ex­ten­sion.

“Votes could change when law­mak­ers hear from their con­stituents the ben­e­fits they are los­ing,” said Robert Weiner, a Demo­cratic strate­gist.

“Let’s say (Congress) got rid of it and didn’t re­place it with any­thing. What hap­pens to those 700,000 peo­ple? What hap­pens to drug treat­ment? What hap­pens to men­tal health coun­sel­ing?” OHIO GOV. JOHN KA­SICH

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.