January 29, 2018


How Trump may end up expanding Medicaid, whether he means to or not (Jeff Stein January 28, 2018, Washington Post)

Republican lawmakers in a half-dozen states are launching fresh efforts to expand Medicaid, the nation's health insurance program for the poor, as party holdouts who had blocked the expansion say they're now open to it because of Trump administration guidelines allowing states to impose new requirements that program recipients work to get benefits.

In Utah, a Republican legislator working with the GOP governor says he hopes to pass a Medicaid expansion plan with work requirements within the year. In Idaho, a conservative lawmaker who steadfastly opposed Medicaid expansion in the past says the new requirements make him more open to the idea. And in Wyoming, a Republican senator who previously opposed expansion -- a key part of President Barack Obama's health-care law -- says he's ready to take another look at fellow Republicans' expansion efforts in his state. [...]

The new Trump administration rules may also shake up the balance of power in state-level struggles over Medicaid expansion. Thirty-two states and the District have expanded Medicaid since the Affordable Care Act was enacted, giving health care to approximately 13 million additional people. (Maine voters approved a Medicaid expansion in a November ballot referendum, but it has not yet taken effect.)

The other 17 states are overwhelmingly GOP-dominated. In many, Democrats and some moderate Republicans repeatedly have attempted expansions, hoping to take advantage of federal funding available to provide health insurance for low-income patients. But they've seen their efforts thwarted by conservative lawmakers and governors, who argue that expansion would give health care to "able-bodied" Americans and explode state budgets.

Now, moderate Republicans hope to win over their conservative colleagues by packaging the expansion with work requirements or other limits on who is eligible for the program, under what circumstances and for how long.

Their chances of success vary widely depending on the state. In Utah, a Republican lawmaker who has opposed a more generous Medicaid expansion is working with a supportive governor and leaders in the state's House and Senate on a version that would include work requirements. [...]

"There will be state legislators who were previously skeptical of Medicaid expansion, but who now think they can get behind it," said Akash Chougule, director of Americans for Prosperity, a right-leaning political advocacy group affiliated with the Koch brothers. "But for us, the fact remains that expanding eligibility will massively increase spending costs. That might be blunted a little bit by a work requirement, but we will continue to resist those calls to expand."

The GOP can't repeal Obamacare, only make it more expensive

Posted by at January 29, 2018 8:11 AM