Feb. 10, 2019
Dive Brief:
- Republican Georgia Gov. Brian Kemp
is requesting a partial Medicaid expansion waiver from CMS. Kemp, who
campaigned against a full Medicaid expansion, said he wants to explore a
smaller option. Democrats in the
state have decried spending money on a waiver proposal rather than going
through with full expansion.
- Meanwhile, in Utah, Republican legislators approved a
more limited version of Medicaid expansion than approved by voters in the
fall. Utah Gov. Gary Herbert
said the voter-approved expansion plan would result in "real problems
when it comes to sustainability and affordability for the
state."
- Democratic leaders in
Republican-leaning states, such as Tennessee and Wyoming, are eyeing
expansion. In Montana, the state's hospital association
agreed to fund Medicaid expansion partially. Montana voters had turned
down a ballot initiative that would have increased tobacco taxes to pay
for Medicaid expansion.
Dive Insight:
Under the Affordable Care Act, states can expand Medicaid to
cover people below 138% of the federal poverty level, and 12 million
people have gained coverage this way. Studies credit Medicaid expansion
with improving people's health, lowering maternal mortality rates, reducing barriers to care and
helping hospitals' finances.
Newly minted House Speaker Nancy Pelosi
recently said Democrats hope to push the 14 non-Medicaid expansion states to
open the programs and Congress may give states more money to expand. However,
some Republicans in Washington back a partial Medicaid expansion for
non-expansion states.
The politics of Medicaid expansion has shifted in recent
years. While most red states opposed it in the early years, the midterms saw
several Republican states change their tune. Idaho, Utah and Nebraska have
approved expansion plans recently. Virginia also implemented expansion this
year.
Still, the Trump administration's CMS has encouraged hurdles
to getting aid, clearing work requirement waivers to eight states. Democrats
and critics say the work rules don't work and hurt the most vulnerable.
Michigan Gov. Gretchen Whitmer
said she plans to make changes to Michigan's Medicaid work requirements before
they go into effect. The Democratic governor is concerned about people losing
coverage. Whitmer pointed to a recent study showing that up to 183,000 Michigan
residents could lose Medicaid with a work requirement.
Other challenges remain for expansion. Despite the millions
of newly insured, many doctors are still cool
to the program. Physicians are less likely to take Medicaid than either
Medicare or private insurance, citing Medicaid's lower reimbursement level. A
recent report suggested that more doctors would take Medicaid if states
improved reimbursement for the program.
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