Republican governors split over ACA Medicaid expansion

Six GOP governors have decided to expand the health program

Topics: Health Policy, Market Trends, Strategy, Payer and Regulatory Policy, Medicaid, Reimbursement, Finance

February 8, 2013

Six Republican governors recently announced that their states will participate in the Affordable Care Act's (ACA) Medicaid expansion, "highlighting a fissure" in GOP opposition to the reform law, the Los Angeles Times reports.

  • How can your hospital prepare for the Medicaid expansion? Join us on Feb. 19 for a discussion of the financial implications of expansion for individual states and facilities.

Under the ACA, the federal government will cover 100% of the cost of the expansion until 2016, and after that the federal share will decline gradually until it reaches 90% in 2020. Thus far, most of the states that have agreed to participate in the Medicaid expansion are governed by Democrats. However, six Republican-governed states have agreed to participate in the expansion.

Where does your state stand on the Medicaid expansion? Click to expand either a quick-to-scan graphic or an interactive graphic. (Note: interactive graphic may not be optimized for mobile devices.)

This week, Michigan Gov. Rick Snyder (R) became the sixth Republican governor—along with the governors of Arizona, New Mexico, Nevada, North Dakota, and Ohio—who has agreed to participate in the expansion, prompting ACA opponents to accuse them of putting politics ahead of the GOP's principals.

According to the Times, Obama won both Ohio and Michigan in the presidential election last fall, while Arizona, New Mexico, and Nevada are home to a large percentage of Latino citizens, a group that is expected to benefit from the expansion.

Regardless, Republican governors who have come out in favor of the expansion say they based their decision on economic figures. For example, Snyder says Michigan is expected to receive more than $20 billion in federal funding through 2023, saving the state a total of $1.2 billion through 2020.

According to the National Journal, some local factors played a role in Arizona Gov. Jan Brewer's decision to support the expansion. The state was forced to suspend enrollment in Medicaid for childless adults, an effort that was enacted by a 2000 ballot initiative. Under the ACA's Medicaid expansion, Arizona would receive more federal funds to restore coverage to eligible residents under the state program.

Despite the Republican defections, 15 GOP governors—including Texas Gov. Rick Perry, South Carolina Gov. Nikki Haley, and Louisiana Gov. Bobby Jindal—have said their states will not participate in the Medicaid expansion. Many of the 15 GOP governors have said they do not believe the federal government will meet its funding commitments.

Observers have said the six GOP governors' willingness to accept Medicaid expansion in their states could influence the decisions of Republican governors who have yet to make an announcement, Washington Post's "Wonkblog" reports.

Bill Pierce, a former HHS official under President George W. Bush, said, "It’s a tipping point." He added, "You’ve now got a real conservative state, a battleground state and a blue state all signed up. If you’re a Republican governor thinking about this, you fit into one of those categories" (West, Los Angeles Times, 2/7; Brownstein, National Journal, 2/7; Helling, Miami Herald, 2/7; Kliff, "Wonkblog," Washington Post, 2/7).

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