Holdout states revisit Medicaid

WASHINGTON — In an ironic twist, the Trump administration’s embrace of work requirements for lowincome people on Medicaid is prompting lawmakers in some conservative states to resurrect plans to expand health care for the poor.

Trump’s move has been widely criticized as threatening the Affordable Care Act’s Medicaid expansion. But if states follow through, more Americans could get coverage.

“I think it gives us a chance,” said Kansas state Rep. Susan Concannon, a moderate Republican who pushed unsuccessfully for Medicaid expansion last year in her state.

In Utah, the office of Republican Gov. Gary Herbert said the Trump administration’s willingness to approve work requirements is one of several concessions the state would demand to cover more poor residents through Medicaid.

Utah state Rep. Robert Spendlove, a Republican working on legislation to partially expand Medicaid, said the Trump administration has sent a positive sign.

“I have a lot of confidence that they will be willing to work with us and approve this,” Spendlove said.

There’s already an economic argument for states to expand Medicaid, since it translates to billions of federal dollars for hospitals and medical service providers. But Republican Mike Leavitt, a former U.S. health secretary and Utah governor, said the ability to impose work requirements adds an ideological motivator.

Under former President Barack Obama’s health law, states got the option of expanding Medicaid to cover more low-income adults.

Thirty-two states and Washington, D.C., expanded, adding about 11 million beneficiaries. But 18 mostly conservative states, including Florida, are still holding out.

Another carrot for reluctant states is the repeal of the health law’s requirement that most people carry health insurance.