Under pressure from the health-care industry and consumer advocates, seven Republican governors are cautiously moving to expand Medicaid, giving an unexpected boost to President Obama’s plan to insure some 30 million more Americans.
The Supreme Court ruled last year that expanding Medicaid to include many more low-income people was an option under the new federal health-care law, not a requirement, tossing the decision to the states and touching off battles in many capitols.
The federal government will pay the entire cost of covering newly eligible beneficiaries from 2014 to 2016, and 90 percent or more in later years.
But many Republican governors and lawmakers immediately questioned whether that commitment would last and whether increased spending on Medicaid makes sense given the size of the federal budget deficit. Some flatly declared they would not consider it.
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In Florida, where Gov. Rick Scott reversed his position and Wednesday announced his support for expanding Medicaid, proponents say that doing so will not only save lives but also create jobs and stimulate the economy.
Similar arguments have swayed the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who in recent months have announced plans or proposals to expand Medicaid.
“I think this means the dominoes are falling,” said Ronald Pollack, the executive director of Families USA, a consumer group. “The message is, ‘Even though I may not have supported and even strongly opposed the Affordable Care Act, it would be harmful to the citizens of my state if I didn’t opt into taking these very substantial federal dollars to help people who truly need it.’ ”
Nationwide, Medicaid covers 60 million people, most of them low-income or disabled. The Congressional Budget Office has estimated that 17 million more people could be enrolled if all states took the expansion option.
So far, 22 states have said they will expand the program, 17 have opted against it and 11 have not decided, according to Avalere Health, a consulting firm.
Some Republican governors remain opposed to the Medicaid expansion. In her State of the State address, Gov. Nikki Haley said, “As long as I am governor, South Carolina will not implement the public-policy disaster that is Obamacare’s Medicaid expansion.”
Gov. Rick Perry affirmed that “Texas will not expand Medicaid” and said he was proud that Texas did not follow other states “scrambling to grab every tax dollar they can.”
The change of heart for some Republican governors has also come after vigorous lobbying by health-industry players, particularly hospitals. Hospital associations around the country signed off on Medicaid cuts under the health-care law on the assumption that their losses would be more than offset by new paying customers, including many insured by Medicaid.
The Obama administration has tried to win over state officials by offering new flexibility to manage Medicaid as they like. On the same day that he agreed to expand Medicaid in Florida, Scott got federal permission to move Medicaid beneficiaries into private-managed care plans.
Scott’s support for expanding Medicaid is particularly significant — Florida is the fourth-most populous state — and surprising. A one-time hospital executive, he has been among the most strident critics of the health-care law, and his opposition to it was a cornerstone of his 2010 campaign for governor.
The battle is not over, however. In Florida, as in many other states, expansion is subject to approval by the Legislature, whose Republican leaders have expressed misgivings. The legislative session begins next month, and advocates say they plan to press ahead with a lobbying campaign.