More States Lean Toward Medicaid Expansion; Florida and Texas Are Long Shots

In 2013, a Medicaid expansion bill nearly passed the Montana Legislature. But a Democratic lawmaker who intended to vote for it accidentally pressed the wrong button. His vote could not be changed because a state law says legislative voting errors cannot be corrected if they would affect the outcome of the vote. The legislature did not meet the following year. This year, the legislature is in session and the balance of power is about the same as it was in 2013.

Tennessee: In December, Republican Gov. Bill Haslam announced he was close to an agreement with the federal government on an alternative expansion plan called Insure Tennessee. Under the proposal, the state would provide vouchers to help low-income residents pay premiums for employer-sponsored insurance. Low-income residents without an employer-offered plan would receive coverage through a plan resembling a health reimbursement account, with premiums and copayments for people with incomes above the federal poverty line.

Insure Tennessee, which would cover more than 300,000 residents, has been under consideration by the federal government for nearly two years.

Utah: Early last year, Republican Gov. Gary Herbert announced details of a plan to expand Medicaid to about 95,000 low-income adults using private insurance, similar to Arkansas’ plan. It would require low-income Utahans to show that they are making an effort to find employment in order to qualify for coverage. This month, he renewed his push to seek legislative approval for his proposal.

Wyoming: Republican Gov. Matt Mead has been discussing an alternative Medicaid expansion idea with the federal government since last summer. In November, he released details of Wyoming’s "Strategy for Health, Access, Responsibility and Employment," or the SHARE plan, that would cover an estimated 17,000 residents. All participants would make copayments, and those with incomes above the federal poverty level would pay monthly premiums of $25 to $50. All participants would have access to employment assistance programs like job search services and vocational rehabilitation, but their Medicaid eligibility would not be affected.

Long Shots

The biggest nonexpansion states are Florida and Texas, where expansion would add a total of 2.6 million uninsured residents to the Medicaid rolls. But both the Florida and Texas legislatures are dominated by Republicans, and expansion remains a long shot.

Alabama and North Carolina also are deep-red states, but Republican governors Robert Bentley of Alabama and Pat McCrory of North Carolina both have made comments recently suggesting they are open to the idea of expanding Medicaid.

Earlier this month, McCrory announced he has had preliminary discussions with the Obama administration about customizing the state’s approach to expansion. In December, Bentley told state lawmakers he would be open to a Medicaid expansion along the lines of Arkansas' "private option," under which newly eligible Medicaid beneficiaries purchase private health plans on the insurance exchange. Neither governor has made public a detailed proposal.

In both Florida and Texas, billion-dollar federal Medicaid funds to compensate hospitals for unreimbursed care are set to expire soon – Florida’s in June and Texas’ in September 2016. Those impending deadlines and other provisions of the ACA are draining hospital revenue in both states. As a result, hospitals are pressuring both governors and Republican lawmakers to allow them to tap into the health law's intended countervailing benefits for hospitals by insuring more residents through a Medicaid expansion.

Republican Gov. Rick Scott of Florida announced his support for expanding Medicaid in 2013, but has not expended any political capital to make it happen. In Texas, former Republican Gov. Rick Perry was among the nation's fiercest critics of the ACA. But his Republican successor, Greg Abbott, told a group of lawmakers in a private meeting last month that he wanted to know more about Utah's alternative model for expansion, according to the Houston Chronicle.

Editor's Note: The following New York Times paragraph is an excerpt from a story To Collect Debts, Nursing Homes Are Seizing Control Over Patients:

"In a random, anonymized sample of 700 guardianship cases filed in Manhattan over a decade, Hunter College researchers found more than 12 percent were brought by nursing homes. Some of these may have been prompted by family feuds, suspected embezzlement or just the absence of relatives to help secure Medicaid coverage. But lawyers and others versed in the guardianship process agree that nursing homes primarily use such petitions as a means of bill collection — a purpose never intended by the [New York] Legislature when it enacted the guardianship statute in 1993."

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More States Lean Toward Medicaid Expansion; Florida and Texas Are Long Shots

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