11 GOP governors, including LePage, fight Medicaid expansion

WASHINGTON — Republican governors, including Maine Gov. Paul LePage, are ratcheting up pressure on President Barack Obama to scale back a key provision of his health-care law.

In a letter to Obama last week, 11 governors asked for a meeting “as soon as possible” to negotiate for greater control over their Medicaid programs.

Among other things, the governors want the option of expanding Medicaid — the state-federal program for the poor and disabled — in a much more modest way than envisioned in the law.

“To make any health care reform truly successful, [the administration] should let states do what they do best — innovate and tailor solutions to the needs of their citizens,” the governors wrote. The letter was signed by Jan Brewer of Arizona, Bobby Jindal of Louisiana, Rick Scott of Florida, Robert McDonnell of Virginia and the governors of Iowa, Maine, Mississippi, Ohio, South Dakota, Utah and Wyoming.

The law calls for opening the program to people with incomes up to 138 percent of the federal poverty level, or about $31,810 for a family of four. That’s more generous than what many states offer. It would result in about 18 million Americans being newly enrolled, according to recent estimates by the Kaiser Family Foundation and the Urban Institute.

In June, the Supreme Court ruled that the federal government cannot penalize states for refusing to go along with the full Medicaid expansion called for in the law as of 2014. Since then, state officials have floated the idea of partly expanding Medicaid. But legal scholars sharply disagree over whether Obama administration officials have the legal power to authorize partial expansions.

Charles Miller, a senior attorney at the law firm Covington & Burling, is advising more than 25 state governments on the issue. He said states are stuck in limbo.

“I don’t see how governors can plan and get legislative authority to do what they want to do without knowing what these ground rules are,” Miller said. “You’re talking about a major program here. Medicaid accounts for 20 to 25 percent of a lot of state budgets.”

Under the law, the federal government would pay the full amount of covering the newly eligible recipients for three years. The federal match would phase down to 90 percent by 2020. But that’s still much higher than the regular federal match rate for Medicaid, which varies from 50 percent to 78 percent.

The governors pushing for a more modest approach want to get the enhanced federal match for a partial expansion — covering people with incomes of up to, say, only 100 percent of the poverty line.

Many of those people without Medicaid coverage could still get insurance by using federal subsidies to buy insurance from private plans. But those plans would probably be less generous than Medicaid and could cost the federal government more. Miller said there’s a strong case to be made that the Supreme Court at least opened the door to partial expansion.

“The court said . . . we’re not allowing you to enforce this so-called mandate,” Miller said. “So what is a mandate when you can’t enforce it? I think it’s not un-sensible to say that a mandate then becomes an option. . . . And in that context does it have to be all-or-nothing? Neither the Supreme Court nor the original statute addressed that point.”

Sara Rosenbaum, a professor of health law and policy at George Washington University, disagreed.

She argued that in approving the expansion, Congress made clear that it was designating a new mandatory-coverage group under Medicaid. And just as with the program’s other mandatory coverage groups — poor children, for instance — Congress intended for this one to be covered in its entirety, not in part.

The Supreme Court decision does not change that, Rosenbaum said, because in his majority opinion, Chief Justice John G. Roberts Jr. specified that the rest of the law was “unaffected” by the court’s decision.

Roberts also wrote that “nothing in our opinion precludes Congress from offering funds under the [law] to expand the availability of health care, and requiring that States accepting such funds comply with the conditions on their use.”

“The court did not say its decision was adding new state flexibility,” Rosenbaum said.

However, she and others contend that Kathleen Sebelius, the secretary of health and human Services, might still be able to permit partial expansion through a different avenue: the secretary’s long-standing power to to waive certain Medicaid rules for states seeking to run demonstration projects.

Here again, though, there is controversy. For technical reasons, legal scholars differ over whether such waivers could be applied to all relevant parts of the law.

David Merritt, a managing director at Leavitt Partners, a health consulting firm that is advising many states, said that for all the legal obstacles and ambiguities, Obama officials will easily surmount them if they decide that the best strategy is to allow partial expansions.

“At the end of the day, they’ll find whatever means they can to make this happen,” he said.

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Comments

Mark Elliott's picture

We elect our representatives

We elect our representatives to not only help move good legislation but also block bad legislation. To look out for us in every way. Democrats do their share of blocking as well...it is their job! The republican party I am part of wants all Americans to be successfull and that simply won't happen when we are all bogged down with taxes and fees.

While democrats want us all to HAVE health insurance, republicans want us all to be able to AFFORD health insurance. Remember the "give a fish, teach to fish" story?? Health care costs will not go down if we are focussed only on making sure everyone gets health insurance. That insurance will be paid for by taxpayers and will not be free! We need to look at the core reason for over priced healthcare.........liability! Texas passed tort reform and their helthcare costs went down which caused their insurance premiums to drop as well. It was a win win for all except lawyers and abusers of the system.

David Lingard Jr's picture

medicaid.......

ok well how about the people who can not afford health insurance.......for example i have one friend who is 63 years old and can not even get on Mainecare because a settlement she got from her divorce......she put it in her grandsons name but also she is still paying for her insurance which is over 300 dollars a month.......it does not cover nothing.......it only covers like 4 to 6 doctors visits and she is lucky not to be on so many meds like i am but that is ridiculous they will not let her on Maincare but they will give her 200 dollars of food stamps.......she does not even need the food stamps really........she is on a fixed income like i am and she does all she can to afford car insurance and medical insurance payments which do her no justice.....they say she needs to keep her account open so that one year in the future she will be bale to get on Mainecare........who maybe when she is at that age it may be to late for her to have that insurance to utilize.......i just do not understand why they are doing this........you realize as someone who is disabled as i am it gets harder to find help now or days because mostly republicans are getting rid of programs that are needed by people like me......and also off subject they are even trying to get people who are allot worse then i am in mental illness to work again........how many people do you think that is going to affect and how many people is that going to scare knowing there are unstable people out there working in public.....it is not about helping the Americans out it about filling pockets of those who are already well in means.......i am sorry for getting so upset but this is what is happening out here in the real world that they do wanna realize......they need to take those silver spoons out of there butt and ears and eyes and see what is really going on........they are also not listening........how all the kick backs of all these retired people Dem. and Rep. still getting all these kick backs and the lavish life style that they still live in.......cut back on them they do not need to continue those lifestyles they need to live in the real world people struggle and have needs......god i hear about all these things and people pointing fingers at who is always wrong and yes i am guilty i am one of them but i try not to though.......that is how stuff is not getting done and how we are in so much debt because of all these kick backs and cut backs.......i mean think about it not everyone can work or be able to budget a limited income to survive now or days.......it is always about the almighty dollar that is fake.......i am glad i have these insurances that i have while i am alive they keep me somewhat healthier then people who chose to drink to cover their problems that's another thing but i will not go into that........sorry so long winded but i am upset about what this country is coming to.......ty

Mark Elliott's picture

David, as I stated in my

David, as I stated in my first response...reduce the cost of healthcare and the cost of health insurance WILL go down as well. WHY is healthcare so expensive?? Many doctors and professionals will tell you their liability is too high. Many have closed up shop because they can no longer afford the malpractice insurance that protects them and their patients. Why does their insurance cost so much??....ABUSE of the system. If we were to pass tort reform across the board, costs all over will go down. No more $5 million dollar hot pickles...you burn your mouth on hot coffee, put some salve on it and get over it! We as a society seem to love suing everyone for everything we can......so yes, it is about money, there is greed from the top all the way to the patient at the bottom.

Forcing everyone into a health insurance pool will not reduce the cost of healthcare. It will only force people to help pay for it that wouldn't normally pay into it.......healthcare costs will continue to rise and soon it will no longer matter how many people are paying into the pool.

As I said, democrats want us all to HAVE healthcare (Obamacare), and republicans want us all to be able to AFFORD healthcare. For many Americans, Obamacare will cost them MORE because it does not cover nearly as much as current private health insurances do.

If you had a choice, lower healthcare costs so you can afford it, or force others to help you pay for it, which would you choose?

David Lingard Jr's picture

medicaid....

i see what you are saying and i agree somewhat about people having to pay to much for the services but i also do not think that anyone would be forced to do anything they do not wanna do......a choice is all people are gonna have a better chance to have insurance even if they do make a little more monies then the reg person on medicaid......i still believe that it should be a choice if they can not afford it they can utilize it.......now if i was working and had more money coming in well yeah of course i would like to have lower health care costs.......and what is all this stuff about forcing people to do things.......who are you referring to all or just the rich actually having to pay a little more taxes which i think they should they have to many breaks to begin with.....also person health care insurance only pays up to what the person can pay for.....with medicaid of which i am on pays for a heck of allot more then reg insurance......i really do not understand why the phrase forcing or forced is used allot with you........i have really not heard of anyone being forced to do anything it is a choice......the only thing about being forced is something that happens to you like rape,sexually molested as a child and physical abuse from an abuser and mental abuse from an abuser.......you in any of the cases have no choice as a child or even as an adult.......all those things my friend i had no choice with how all these things happened to me.......with medicaid i chose to be on it because of my illnesses of which i have no choice over either.......those are what you have no choice over.......but all these things you are referring to as being forced to do......no you have a choice not to have to pay these things.....okie dokie i am sorry i am real touchy about these things......medicaid also pays for other programs as i need as well that reg health insurance will not pay for because they do not think it is worth them paying for they have alot of choices of what to pay for and what not to.

Mark Elliott's picture

My use of "force" was in

My use of "force" was in reference to Obamacare.......Obama says it's voluntary, but when companies are told "provide private insurance or be fined so your employees can go on national healthcare"....that's force. What conservatives have said will happen has now started happening......employers are quickly realizing the fine is cheaper than the private insurance so they will be cutting out the insurance and forcing employees onto the national healthcare system. The only way the national healthcare system will be able to sustain with so many people using it is to raise the patient responsibility portion of it and take more from us in taxes..........which for many, will already be higher right from the start than what they are paying now. Our health insurance will cost us more and our quality of health will drop.........

 's picture

Republican Governors

As usual the Republicans only want what they see best for their party, they don't care about the poor or disabled. The only reason that the vast majority of states voted all Republicans into office when they did, it was in hopes to oust President Obama out of office. The same as they tried to oust President Clinton out, but their plan backfired on them. We ended up with 4 more years of Clinton, and their plan backfired on them again, as we ended up with 4 more years of Obama. It is their own fault for wanting things their way, and not the right way.

David Lingard Jr's picture

medicaid.......

here we go......when the president wants to do something about a program for the united states the republicans wanna vito it because most likely it is going to lesson what is in there pockets for monies.....this is one reason i see that the president has not been able to do anything because when he wants to better for others the republicans say wo and then stops it. whats wrong with letting other people in on the rights to have insurance that they can afford......these other insurances are so freakin expensive and no one can afford them......these other insurances make it hard for people to live......they also have to make people decide weather or not to eat or to pay to have medical attention of which they still can not afford the payments or copay......let the president work and do his thing.......i am sure there is a method to his madness.

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