Medicaid expansion is slowly gaining exception in the deep south as both Alabama and Louisiana are heading toward expanding the program to cover thousands more Americans. Taken together, the two states could expand coverage to more than 330,000 low-income people. And they could mark the beginning of the end for a region that has steadfastly refused to cooperate on President Obama’s health coverage expansion.
Republican governors and state legislatures in the deep south are starting to embrace ObamaCare and are increasingly hopeful that Medicaid expansion is finding more acceptance. At the moment there is not a single state in the lower south has accepted the standing offer under ObamaCare to expand Medicaid to people living up to 138 percent of the poverty line, which is about $33,000 for a family of four.
The Louisiana legislature passed a bill this summer to allow the next governor to expand Medicaid, an optional part of the Affordable Care Act. In the lead-up to the state’s gubernatorial election on November 21, both candidates, Republican Sen. David Vitter (who is running for governor), voiced his support for expansion.
“I believe we should bring our federal tax dollars back to Louisiana, to help us meet our obligations to our people when they allow us to save money in the process especially, and certainly that includes Medicaid expansion,” Vitter said at an event last Friday.
“Where we are now is facing a law that’s on the books and the issue of Medicaid expansion,” Vitter said last week, according to the Associated Press. “I said from the beginning of the campaign, I would not rule it out. But I would only do it on solid, sound Louisiana-terms, not on the federal government’s terms.”
The Obama administration seems to be willing to with states to craft a way to with states to get Medicaid expansion done as long it stays within the framework of the Affordable Care Act.
While, 30 states have moved forward on Medicaid expansion, 20 states including the state of Florida have not participated in the program, leaving millions of Americans in a “coverage gap”: They earn too little to qualify for subsidized private insurance but don’t have a Medicaid option available, either.
Over in Alabama Jim Carnes, policy director at Alabama Arise, a non-profit aiming to help low-income people and a member of the governor’s commission, said that something along the lines of the Arkansas model is possible.
Some sort of provision related to encouraging enrollees to work is also possible, he said, though the Obama administration has so far rejected full-on work requirements.
The commission as a whole, which included state legislators from both parties, likewise proposed an “Alabama-driven solution,” indicating that some modifications to the Medicaid program could be necessary. While those details are still to be worked out,
Carnes says he sees positive signs from the governor about agreeing to some form of Medicaid expansion.
“I think he’s really been pointing in that direction and will make his move in the near future,” Carnes said. Meanwhile, Alabama Republican governor Robert Bentley recommended expansion. He said earlier this month that he is “looking” at the possibility of broadening Medicaid.
“I was personally against the Affordable Care Act,” he said last month, according to the Alabama Media Group. “I never called it ObamaCare because it’s not a person, it was a philosophy.”
“But we lost folks. We lost. And we lost in court,” he added. “So what we have to do now is move past that, take the resources we have available and try to improve the quality of life for the people of Alabama, and that’s exactly what I’m going to do.”
Supporters of Medicaid expansion hope that if they can get a foothold in the South, other states will follow.
While no one expects Alabama expand the healthcare program without some changes. The department of Health and Human Services continues to work with the states while getting creative on how to negotiate with the administration to put a conservative twist on the program, as other Republican-led states have done.
The template that you are likely to see is the Arkansas model, where the expansion enrolls people in private health insurance plans instead of government-run Medicaid.
One of the things pushing states towards expansion, despite the divisive politics of ObamaCare, is the infusion of federal money it provides. Hospitals have also been strong advocates for expansion, as coverage for more people reduces the amount of care they have to provide to the uninsured without compensation.
The clock is also ticking to take full advantage of federal funds, as 2016 is the final year that the federal government will pay for the entire cost of expansion.
“What is going to happen is that support for Medicaid expansion will continue to build,” Secretary of Health and Human Services Sylvia Burwell told Atlanta Magazine in an article published Monday. “You hear the Alabama governor. You’ve heard conversations in Louisiana.”
Thirty states have taken the Medicaid expansion so far, but in some of the remaining states, including Tennessee and Utah, Republican governors are on board, but not the legislatures. Asked by Atlanta Magazine whether she thought it was “just a matter of time” before all states expanded Medicaid, Burwell replied, “Yes.”
Burwell said she has high expectations for Alabama and the rest of the country.