Hospitals are preparing for a state-by-state battle to convince their leaders to opt into the Affordable Care Act's (ACA) Medicaid expansion, after last month's Supreme Court ruling gave states an out.
Under the ACA, states were originally expected to expand Medicaid eligibility to residents making up to 133% of the federal poverty limit. That would have added an estimated 17 million residents to the program if implemented in all 50 states.
However, the Court's ruling on the ACA leaves each state's decision to participate in the hands of the nation's governors and state leaders—and several governors already have said they plan to opt out.
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Hospitals prepare lobbying campaigns
Many GOP leaders have pledged to oppose the expansion, so advocates for providers and uninsured residents are developing state-level campaigns to pressure them into changing their minds, Modern Healthcare reports. "You're going to see a major intensification of lobbying at the state level by the hospitals and the doctors," says John Gorman, a consultant and former lobbyist.
For example, Gov. Rick Perry (R) over the weekend said he does not plan to have Texas participate in the ACA expansion. In response, the Texas Hospital Association (THA) and its 500 member hospitals plan to build "significant" political pressure on state leaders to participate in the expansion, according to THA lobbyist John Hawkins.
Meanwhile, South Carolina Hospital Association lobbyist Allan Stalvey says his group will push state legislators to change their minds and pursue the expansion. "We're hopeful we can work something out," he says.
Although some observers say state Republican leaders will soften their opposition to the expansion after the fall elections, experts say that waiting to launch the expansion until then could force hospitals to miss the law's January 2014 start date.
Working around gubernatorial opposition to the law
In some states, hospitals are looking for ways to circumvent governors' opposition to ACA. Several organizations are exploring whether HHS could force states with pending Medicaid waivers to pursue the expansion.
For example, Florida Hospital Association President Bruce Rueben says Florida's application to shift Medicaid beneficiaries into managed care could force the Medicaid expansion. "That process, alone, gives the state and federal government reason to negotiate," he says.
Similarly, Wisconsin has a waiver pending for a new Medicaid benchmark for benefits and cost-sharing. Expansion advocates are urging the Obama administration to trade approval of the waiver for the state's participation in the Medicaid expansion.
Some hospital leaders express concern about Medicaid expansion
Although most hospital leaders appear to support the Medicaid expansion, some have expressed concern with its possible impact.
For instance, Sheldon Retchin—CEO of Virginia Commonwealth University Health System—says the expansion could exacerbate ED crowding if office-based physicians are unable to cope with a surge in Medicaid patients.
Meanwhile, Brian Dean—VP of finance at Jackson Health System in Miami—says Jackson may not support the expansion if it leads to diverting indigent care funds elsewhere (Daly, Modern Healthcare, 7/7 [subscription required]; Newkirk/Selway, Bloomberg, 7/9; Burton et al., Wall Street Journal, 6/29).