Governors run into legislative walls on the Medicaid expansion


Republican governors who have pledged support for the Affordable Care Act's (ACA) Medicaid expansion are running into logjams in their states' GOP-led legislatures, the Wall Street Journal's Arian Campo-Flores writes.

The Supreme Court's ruling on the ACA last year left the decision to participate in the expansion to the nation's governors and legislatures. Although most Republican governors say they will reject the expansion, some are pushing for the federally funded coverage expansion in their states.

However, intraparty conflict threatens to derail proposals to expand health insurance coverage for low-income residents in Florida, Michigan, Ohio, and Arizona.

Opponents of the expansion—including conservative lawmakers and think tanks—say that expanding Medicaid would create new financial obligations for states. Although the federal government has pledged to cover 100% of the expansion's cost for the first three years, that support will drop to 90% thereafter. Moreover, Michigan House Speaker Jase Bolger (R) contends that the federal government "has a long history of pulling back from its promises and leaving the state holding the bag."

The intraparty schism in certain states is likely a result of the different constituencies that governors and lawmakers serve, says Carol Weissert, a professor of political science at Florida State University. "Rick Scott represents the state, whereas a lot of these Republicans represent much narrower, conservative districts," she told Campo-Flores.

Additionally, lawmakers—unlike the executive branch—are "not responsible for running programs," notes Alan Weil, who serves as executive director of the National Academy of State Health Policy. "Ideological purity is easier to sustain when you're a legislature," he says.

Expansion advocates—including hospitals and chambers of commerce—argue that providers will see an influx of newly covered patients that will help offset reduced payments for uncompensated care under the ACA. "We have this unprecedented and unique opportunity to help struggling families," says Leah Barber-Heinz, advocacy director for Florida Chain, adding, "These are our tax dollars. If we don't spend them, they will go to other states" (Campo-Flores, Wall Street Journal, 5/2).

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