State Republicans warm to Medicaid expansion | #republicans | #Alabama | #GOP

A few of the remaining states that have not expanded Medicaid appear poised to take another run at it next year.

A change of heart by some lawmakers in these GOP-controlled states signals support is growing in favor of expanding eligibility for Medicaid, the federal and state program that helps with healthcare costs for some people with limited income and resources. States have had the option to expand Medicaid programs since the enactment in 2010 of the Affordable Care Act, former President Barack Obama’s signature domestic achievement, which has drawn opposition from some Republicans.

Thirty-nine states and the District of Columbia have already adopted Medicaid expansion, with South Dakota approving a referendum in support of it last month. Eleven states have resisted efforts so far, though Kansas, North Carolina, Wyoming, and Alabama are likely to renew discussions over Medicaid expansion in the new year.

State opponents of Medicaid expansion cited different reasons for doing so. But one common thread of criticism is that Medicaid raises premiums for those with private insurance. These critics contend that because both Medicaid and Medicare underpay doctors and hospitals for their costs of care, providers make up the difference by charging higher rates to private insurers.

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Still, in North Carolina, at least, such concerns are starting to recede.

“I do believe that next year when we go back for the long session, there will be a lot of negotiations and discussion around expansion. I think we have a really high chance of passing it this next year in North Carolina,“ said North Carolina state Rep. Donny Lambeth (R).

Medicaid experts have suggested that North Carolina could be the first to take action on the issue. Both chambers of the Republican-led North Carolina legislature passed bills in favor of expansion in 2022, with Democratic Gov. Roy Cooper supportive of it. But they were unable to come to an agreement on whether to attach other healthcare reforms to the legislation.

The votes signal a potential ideological shift that has been years in the making in a state that has long opposed expansion efforts as several key Republicans, like state Senate leader Phil Berger, change their stances on the issue.

Lambeth said he was optimistic that both chambers could work out a deal in the next session, noting that last year was the first time recently that both chambers were able to get on board for expansion in the same year.

In Wyoming, a joint legislative committee held a meeting last month to look at how Medicaid expansion had been implemented in neighboring states like Montana with the goal of drumming up support for an expansion bill in the upcoming session.

“I am definitely encouraged that despite the fact that there’s been a little bit of a rightward turn in Wyoming that this could be a good year for Medicaid expansion,” said state Sen. Cale Case (R). “I can detect much more support from the business community for this, and that will make a huge difference.”

Case, who was once opposed to expansion but has been staunchly in favor of it in recent years, said the threat of a progressive ballot initiative for Medicaid expansion might encourage his Republican colleagues to take action on the issue.

“This Medicaid expansion campaign has a lot of people that want it and a lot of support for it. So if the legislature doesn’t do it, there are already efforts beginning with regard to an initiative, and I do know my colleagues, even though it’s kind of hard to do an initiative in Wyoming, they’re afraid of what an initiative would do, so they’d like to get ahead of it,” Case said.

Seven states have adopted Medicaid expansion through ballot initiatives, including several in Republican-led states — most recently, South Dakota, as well as Oklahoma and Missouri. Wyoming is one of the remaining states that hasn’t adopted Medicaid expansion where a ballot initiative is an option.

Lawmakers in Kansas and Alabama could also resume Medicaid expansion efforts next year as both governors signal support for it, though it is likely to face an uphill battle for approval.

Justin Bogie, a senior director of fiscal policy at the Alabama Policy Institute, which opposes expansion, said Alabama Gov. Kay Ivey (R) has previously been against it but has recently hinted that she would be more open to proposals.

Bogie said despite some receptiveness to expansion, the financial logistics behind proposals are stacked against it in the state.

“There’s this assumption that a lot of new tax revenues will come in for Medicaid expansion. But the issue with that is it seems like most other states that have expanded Medicaid, they’ve increased provider taxes and hospital taxes. So again, that would be a cost that’s ultimately going to be passed back on to healthcare consumers,“ Bogie said.

In Kansas, top Republican lawmakers remain firmly opposed to Medicaid expansion, though newly reelected Gov. Laura Kelly (D) has pushed for increasing access for low-income adults in the state.

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A provision in the Affordable Care Act expanded Medicaid eligibility to adults under the age of 65 with incomes up to 138% of the federal poverty level, allowing more low-income individuals to qualify for coverage, though in 2012, the Supreme Court ruled that it was up to states whether to participate or not.

The latest discussions over Medicaid expansion come as the Biden administration signals it anticipates unwinding the COVID-19 public health emergency as soon as next year, which allowed millions of people to remain enrolled on Medicaid as states were required to offer continuous enrollment in order to receive additional federal funding. The American Rescue Plan Act of 2021 also offers states additional financial incentives to expand Medicaid.