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Will Obamacare’s Medicaid Expansion Continue?

Bloomberg View Entertainment Memo Pad Politics

Will Obamacare’s Medicaid Expansion Continue?


Is Medicaid expansion a one-way street?

Greg Sargent asked good questions on Wednesday about the future of the Affordable Care Act: With Medicaid expansion responsible for some 75,000 new signups in West Virginia, will Republican U.S. Senate candidate Shelley Moore Capito campaign against it? With the rollout of Kentucky’s state-run exchange expanding health care access through the state (it’s far more successful than HealthCare.gov), what will Republican senator Mitch McConnell say about it during his re-election campaign?

For the next two years, there’s no chance of a vote to repeal Obamacare overcoming a presidential veto. That’s not the case, however, at the state level, where governors and state legislatures have a fair amount of leverage over the program’s implementation — especially, thanks to the Supreme Court, over Medicaid expansion. Since October 1, more than 6 million have signed up for Medicaid in those states expanding coverage. (The law was designed for Medicaid to do much of the heavy lifting expanding insurance coverage.)

The optimistic liberal view is that the Medicaid deal for the states, in which the federal government covers all expenses for the first three years and 90 percent of costs thereafter — is so generous that eventually every state will sign up. That’s more or less what happened with the original Medicaid, though it took 17 years for the last straggler, Arizona, to join. Liberals assume that once benefits are extended, no government will take them away.

With that (and Greg’s questions) in mind, I took a look at one set of evidence: What are Republican gubernatorial candidates saying about Medicaid expansion in states where Democratic governors have implemented it?

Before I get to the answer, some serious caveats. First, I looked at the websites of nine Republican candidates in the six states (1) that expanded Medicaid, and (2) where Republicans are deemed to have the best chance of winning the statehouse, according to a Washington Post look at these 2014 elections. So it’s only a subset of all Republican candidates.

Second, it’s still early; three of the nine candidates had no issues area on their sites. Third, it’s possible that candidates have staked out public positions that aren’t reflected on their campaign sites. Fourth, candidates could act on the issue, if they were elected, even if they downplayed it during the campaign. Still, the websites provide a hint of what these candidates are most eager to campaign on, and that probably has at least some positive correlation to what they would actually do if elected.

And the answer? Nada. Zip. Nothing. None of these Republicans is pledging to repeal the Medicaid expansion put in place by a Democratic governor.



  1. daniel bostdorf January 24, 2014

    The medicaid expansion MUST continue because there is a small minority of upper lower/lower middle income wage earners caught in the middle because they ” much money and some of the plans can penalize that.

    Now this minority of taxpayers could switch to a long form, take as many deductions as possible, and even starting a DBA sole properietorship and take business loss/profits there….but when you are working 2 jobs or even one to make a mere $36K….you dont have time to do this NOR can you afford a finacial advisor to do it for you…

    The solution is simple: expand medicaid coverage to cover the gap that lower/middle income wage earners at $36K face….

    A person with no deductions making $36k a year should have to pay $200+ a month for a plan….

    The ACA has provisions to amend as needed to cover these lapses and medicaid will be expanded….it has to be. Medicaid itself when first rolled out was tough and addditional provisions and coverages were added.

    It is time to do the same…

  2. Dominick Vila January 25, 2014

    The truth is that after robust opposition, and demonization, Republlcan Governors saw an opportunity to benefit from the financial bonanza that the MEDICAID expansion means to most states. The Federal government is covering the entire cost of the expansion for 3 years, and will cover 90% of the cost after that.
    In addition to being an integral component for a successful implementation of the Affordable Care Act, the MEDICAID expansion helps millions of unemployed Americans, the poor, and the elderly. Many of the latter use MEDICAID to help them pay nursing home expenses. The end result is that the Federal government is helping the states pay for things that would have ordinarily been provided by state governments, thus making funds available for the states to invest on other projects.
    The MEDICAID expansion is a win/win for everyone, and the GOP is well aware of that. That’s the reason they are reluctant to bring it up, and prefer to focus their political attacks on ACA without mentioning that without the MEDICAID expansion ACA would not survive. Rhetoric is cheap.

    1. Independent1 January 25, 2014

      Dominick, what’s really unfortunate, is that despite all the benefits you pointed out or states that are accepting the Fed’s funds for expanding Medicaid, there are still clueless governors like Paul LePage here in Maine, who continue to put up ideological roadblocks to accepting those funds; which has resulted in leaving about 70,000 Mainers unable to get Medicaid benefits that LePage threw off the benefit rolls 3 years ago. When 1st elected, he and the then GOP legislature (they’re no longer a majority) passed tax cuts for the wealthy which because of the reduced tax revenues, they had to cut the budget somewhere – so guess where – 70,000 Mainers were dropped from the program and still haven’t been picked back up.

  3. howa4x January 25, 2014

    One issue that the republicans are aligned with billionaires on is the work for less economy. Here the large retail operations and large food chains depend on state government to give their employees the benefits that they refuse to give. McDonalds even coaches employees how to apply for food stamps, Medicaid and housing assistance. So it is interesting that the republicans unwittingly are going against their corporate masters by either not taking the Medicaid expansion and/or cutting SNAP or Food stamps. The result of this is to have more pressure come to the corporations in the form of unionization pushes toward employees and pressure to raise the minimum wage by the public. As income inequality becomes the democratic message more attention is being paid to these renegade companies and their practices. So where this ties together is that it will open a big debate about who is on Medicaid and why, so any republican candidate has to tread lightly on this issue. Another avenue of pressure will come form the hospitals that have to treat the uninsured. They will start billing the state for services and if the state refuses payment they could close. I’ve seen it happen. This will be a dicey issue for anyone running for state office.

    1. Independent1 January 26, 2014

      Here’s the link to a CNN article about how the GOP’s refusal to fully implement Obamacare is closing hospitals; which in some cases is resulting in people dying because the nearest open hospital is more than 30-45 minutes away and patients (including accident victims) are dying before they can get to the hospital.

      GOP obstruction of Obamacare is closing hospitals
      By Sally Kohn
      updated 7:22 AM EST, Thu December 5, 2013


  4. elw January 25, 2014

    Speaking from the 30+ years of professional experience I have had in health care watching and helping with the implementation of Federal health programs that the States get money for implementing, the Medicaid expansion will continue to expand in those State that have initially refused them. It is common practice for more Conservative States to reject any Federal level program and then to eventually give in, simply because the money is too hard to pass up and eventually they get enough public pressure that they have to. I can also tell you that the very same States commonly have far less successful enrollments and are less efficient in running the programs. Which is sad because they are the same states with the highest percentages of people on food stamps and welfare and have the least healthy populations.

    1. Independent1 January 25, 2014

      Unfortunately, governing in a way that creates less healthy populations, as you point out, also leads to citizens of Conservative states having shorter life spans; and to having higher infant mortality rates (infants not surviving childbirth or to their 1st birthday).
      That may be due to conservative states cutting back on healthcare for poor expectant mothers, e.g., not expanding Medicaid, and also to them not providing enough food stamp support for the poor to feed their infants the correct food (13 of the 15 states with the highest infant mortality rates are conservative states and citizens living in conservative states on average live 2 year shorter lives than citizens of liberal states).

      1. elw January 26, 2014

        Absolutely, when people do not have access to healthy and fresh foods and at least basic health care, they die younger. That has been proven over and over again. Many of our most Conservative State have large numbers of people who live much like they do in 3rd world countries. Pretty sad for the richest Country in the world.

        1. 1standlastword January 28, 2014

          And by clever machination the current conservative political class continues to snaffle red state inhabitants votes by influencing them to think this current GOP is their father’s conservative party.

          How much self emulation will it take before they turn on these false conservative poseurs????!

          Progressives are deemed public enemy number one by this permanent political class of conservatives so NO progressive argumentation can make a dent in the armor of their ignorance.

          They are basically FUBAR due to their unrelenting faith in their false conservative permanent political class leadership

          1. elw January 28, 2014

            Never forget that in nature only the smartest, healthiest and most adaptable of a species survives over the long run. None of that applies to the GOP and their members. Although they do not believe in evolution, watch as they provide a good example of it.

          2. 1standlastword January 28, 2014

            I hope they survive long enough to see the light of the truth that they have become experimental in a false-conservative political laboratory that seems to be testing the limits of the human will to survive under substandard conditions

            Even the faithful among them–those who reject science–should realize their god didn’t create them to be slaves to the corporate master and its lackey false-conservative permanent political class operatives

            How many red state voters are scrapping the peanut butter jar because their congress persons refuse to restore long term unemployment benefits? Do they blame Obama??

          3. elw January 28, 2014

            Oh no forget about them feeling betrayal, that would require thinking. They will stand on the edge of their grave and ask those around them “what happened?”

          4. 1standlastword January 28, 2014

            Then with their metaphorically speaking “death” the red south turns to purple to blue…sorta like TX …potentially

          5. elw January 28, 2014

            You never know, it could happen. Sounds good to me.


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