Health care op­po­nents swell in wake of midterms

The Washington Times Weekly - - Politics - BY TOM HOW­ELL JR.

Vot­ers dealt a blow to Oba­macare in a num­ber of states this week when they re­elected GOP gover­nors who had op­posed the law, and even added a few to their ranks, mak­ing the cli­mate less hos­pitable for Pres­i­dent Obama’s plans to ex­pand Med­i­caid.

Demo­cratic chal­lengers fell short in Ge­or­gia, Kansas and Maine, ef­fec­tively killing hopes for Med­i­caid ex­pan­sion in those states, while Gov. Scott Walker and Gov. Rick Scott sur­vived tight re-elec­tions in Wis­con­sin and Florida, re­spec­tively, leav­ing Oba­macare sup­port­ers doubt­ful that ei­ther state will move to cover more res­i­dents.

And with Gov.-elect Asa Hutchin­son, a Repub­li­can, pre­par­ing to take over for a re­tir­ing Demo­crat in Arkansas, that state’s ex­per­i­ment with a “pri­vate op­tion” form of Med­i­caid ex­pan­sion could be in dan­ger.

Tues­day’s elec­tions shifted the ground on Oba­macare, break­ing a four-year-long stale­mate and putting Repub­li­cans on of­fense when they take con­trol of the Se­nate next year.

House Speaker John A. Boehner said Thurs­day they will hold more votes to re­peal the en­tire Af­ford­able Care Act, which are likely to run aground again, but will also pass a num­ber of smaller bills un­do­ing ev­ery­thing from the law’s in­di­vid­ual man­date to its tax on med­i­cal de­vices to the in­de­pen­dent pay­ment ad­vi­sory board, which Mr. Boehner termed Oba­macare’s “ra­tioning board.”

“There are bi­par­ti­san ma­jori­ties in the House and Se­nate to take some of th­ese is­sues out of Oba­macare. We need to put them on the pres­i­dent’s desk and let him choose,” Mr. Boehner said.

At the state level, in­com­ing gover­nors who are tak­ing over for Democrats, like Mr. Hutchi­son, might try their own roll­backs.

Mr. Hutchin­son has said Arkansas’s Med­i­caid pro­gram, which lever­ages fed­eral dol­lars to buy pri­vate in­surance for newly el­i­gi­ble res­i­dents, is a “pi­lot project that can be ended if needed.”

But with more than 200,000 Arkansans al­ready en­rolled, the new gov­er­nor may have to find a way to rein in the pi­o­neer­ing plan with­out scrap­ping it al­to­gether.

“It re­mains very dif­fi­cult to take back a ben­e­fit you’ve al­ready given,” said El­iz­a­beth Car­pen­ter, a di­rec­tor at Avalere Health, a Wash­ing­ton-based con­sul­tancy.

Oba­macare’s framers ex­pected ev­ery state to aug­ment the fed­eral-state en­ti­tle­ment, but in 2012 the Supreme Court said states could choose not to ex­pand their pro­grams with­out for­feit­ing their ex­ist­ing fed­eral money.

Ac­cord­ing to the Kaiser Fam­ily Foun­da­tion, 27 states and the Dis­trict of Columbia have opted to ex­pand, 21 states have re­fused, and two are in limbo — Utah is de­bat­ing the op­tion, and In­di­ana is wait­ing on a fed­eral waiver to im­ple­ment its own ver­sion of ex­pan­sion.

With Med­i­caid be­ing a key to hit­ting his tar­get of cut­ting the num­ber of unin­sured, Mr. Obama and his al­lies took to the cam­paign trail to try to pres­sure re­luc­tant states to sign up.

In Maine, Gov. Paul LePage found him­self un­der at­tack from Demo­cratic chal­lenger Michael H. Michaud, who voted for Oba­macare in the House, and who said he’d write a Med­i­caid ex­pan­sion bill his first day in the gov­er­nor’s man­sion.

But Mr. LePage, who ve­toed five ex­pan­sion bills in his first term, de­feated Mr. Michaud on Tues­day.

In Ge­or­gia, mean­while, Demo­cratic chal­lenger Ja­son Carter’s plat­form in­cluded ex­pand­ing Med­i­caid — but GOP Gov. Nathan Deal re­jected that, and his al­lies ran ads at­tack­ing Mr. Carter’s stance. Mr. Deal com­fort­ably won re-elec­tion.

“There weren’t quite as many shifts as we thought would be pos­si­ble,” Ms. Car­pen­ter said.

Some gover­nors have tried to find a mid­dle ground. In Wis­con­sin, Mr. Walker made sure that peo­ple mak­ing up to 100 per­cent of the poverty level would qual­ify for Med­i­caid, elim­i­nat­ing the “cov­er­age gap” that hit peo­ple in other non­ex­pan­sion states.

But he has de­clined to support ex­pand­ing Med­i­caid to cover up to 138 per­cent of the poverty line, as Mr. Obama wants.

Penn­syl­va­nia was a no­table ex­cep­tion to the pro-GOP wave.

Demo­cratic gov­er­nor Tom Wolf will take the reins in Harrisburg just as his Repub­li­can pre­de­ces­sor’s Healthy Penn­syl­va­nia plan takes root. And he may try to re­place de­part­ing gov­er­nor Tom Cor­bett’s pro­gram — a pri­vate op­tion-style plan with cer­tain pre­con­di­tions for en­rollees — with a more tra­di­tional form of Med­i­caid ex­pan­sion sev­eral months from now.

As it stands, el­i­gi­ble res­i­dents will start to en­roll in Jan­uary, and Mr. Wolf will have to gain support from the leg­is­la­ture for any al­ter­na­tive in line with the Obama ad­min­is­tra­tion’s orig­i­nal in­tent.

“I think the vot­ers would ac­cept ei­ther one,” said G. Terry Madonna, a pol­i­tics pro­fes­sor at Franklin and Mar­shall Col­lege in Lan­caster, Penn­syl­va­nia, who has polled res­i­dents on both Mr. Cor­bett’s plan and tra­di­tional Med­i­caid ex­pan­sion.

AS­SO­CI­ATED PRESS PHOTOGRAPH­S

House Speaker John A. Boehner of Ohio said the Repub­li­can-con­trolled Congress will hold more votes to re­peal the Af­ford­able Care Act.

Gov. Rick Scott (top) and Gov. Scott Walker (above) sur­vived tight re-elec­tions in Wis­con­sin and Florida ef­fec­tively killing hopes for Med­i­caid ex­pan­sion.

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