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Medicaid Expansion Still a Tumultuous Fight in Several States

Five years after Affordable Care Act, only 30 states have signed up

Five years after the Patient Protection and Affordable Care Act (PPACA) was passed, its Medicaid expansion provision is still causing dissension in state legislatures, according to Kaiser Health News.

Twenty-four states and the District of Columbia said “yes” to Medicaid expansion when the Act went into effect. Since then, only six more have signed on. States that do sign receive billions of additional federal dollars, but many Republican lawmakers are reluctant to say “yes.”

The fight garnered headlines in Florida recently as the Republican-led House and Senate are at odds on expansion, and the legislative work — including setting a budget — came to a standstill. But the issue has also been hot out west, where four Republican-majority states took up Medicaid expansion. Wyoming said “no;” Utah’s governor is trying to negotiate a compromise with Washington that he can offer to the state’s legislators; and Alaska lawmakers are still wrestling with the issue. After some legislative fireworks, Montana said “yes.”

Montana lawmakers had been stewing over Medicaid expansion since they said “no” to it in 2013 –– the last time they met. When they reconvened in January, Americans for Prosperity (AFP), a conservative group, targeted moderate Republicans, organizing anti-expansion “town hall” meetings in their districts.

Tea Party lawmakers in the Montana House also fought hard against Medicaid expansion. They helped defeat a proposal by Democrats, and then nearly derailed a Republican-sponsored compromise. The House had to bend its rules to bring the bill to the floor for a vote. But in the end, 20 Republicans felt politically safe enough to cross party lines and vote with all the Democrats to pass it.

Still, at the bill’s signing ceremony Republican Senator Ed Buttrey, who sponsored the bill, said, “This is not Medicaid expansion.”

Buttrey claimed that Republicans won important concessions from Democrats to make Montana’s bill more palatable to conservatives. People will have to pay small premiums, and the bill also sets up job training and education programs. Buttrey insisted that Montana isn’t just doing the bidding of the White House.

“I’ll say it again, and I hope the media will report this exciting and unique story,” he said. “This is not Medicaid expansion.”

Montana’s proposal is now on its way to federal officials, who will have the last word on whether it’s legitimate under the PPACA.

In Alaska, Governor Bill Walker, a former Republican who is now independent, has made Medicaid expansion one of his top priorities. But Republicans leading the state House and Senate blocked expansion during the legislative session that just ended.

One of those opposed is Senator Pete Kelly. “I think everyone agrees that Medicaid is broken,” he said. “To put more money into it, to bring more people into it, that’s certainly not going to help its brokenness.”

Alaska is currently facing a massive budget deficit because of the plunge in oil prices. And Walker says that even in better financial times, Alaska doesn’t usually decline more than a billion federal dollars.

“If that was a road project or if that was some infrastructure project, we would be all over that,” he says. “This is health care.”

Walker has proposed expanding Medicare on his own if lawmakers don’t act, but it’s not clear that he has the authority. Approximately 40,000 people would qualify for Medicare if Alaska expands the program. About 30% of this group consists of Alaska Natives.

Source: Kaiser Health News; May 12, 2015.

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