Hospitals Push Hard for Medicaid Expansion

The hospital lobbyists in the “no way” states are trying to get the Governors to reverse course.

There are clearly billions of dollars at stake as the states consider their options related to Medicaid expansion. Some of the states – like Florida, where Governor Scott originally announced opposition to Medicare expansion – have now reversed course, in large measure because of pressure from hospital groups. But, simply getting a Governor reverse course is not enough. In the case of Florida, the hospital lobbyists must also work their magic on the legislature. In that state, the Florida House committee responsible for Medicaid legislation shot down a proposal that is even more modest than what Governor Scott has proposed. So, the battle continues. While there seems to be a clear move towards embracing some type of expanded Medicaid program, the approach in the Florida state legislature is with two very different proposals in the Senate and the House, which would expand the health insurance program for low-income citizens. It’s still not resolved.

The same battles are being played out around the country. However, since most of the state legislatures will be closing up shop over the next month or so, we should anticipate that clarity will come to the forefront on where the states intend to go related to Medicaid expansion. While the specific lobbying focus varies in each of the states, the general theme has been the economic benefits that accrue to the state through the influx of federal money in the form of Medicaid support dollars. Here is a state-by-state analysis where discussions are still occurring:

Arkansas – The legislature has yet to approve a budget bill that would call for a plan to use federal Medicaid dollars to buy private health insurance for low-income residents. The “private insurance” program was negotiated by Governor Mike Beebe (D-AK) back in February.
Nebraska – It seems that in the Cornhusker state, many in the state legislature want to proceed with a proposal to expand Medicaid, but Governor Dave Heineman (R-NE) is opposed. The legislature has even built-in a “re-evaluate” clause, but the Governor is opposed even with that approach. The unicameral legislature will likely make a go-no go decision this coming week.
Colorado – Colorado Senate recently passed a program to expand Medicaid in a direct party vote except for one Republican who joined the Democrats. The state Medicaid program would add about 160,000 Colorado adults to health insurance program.
Kentucky – Governor Steve Beshear (D-KY) in a recent news conference noted that he is “getting a lot of pressure from the medical field – particularly hospitals – to approve the expansion.” He has noted that he intends to make a decision on whether to propose a Medicaid expansion by July 1.
Texas – State Representative John Zerwas (R-TX) will be submitting a proposal to the Texas House to create a state-based premium assistance plan, which would result in a modest expansion of coverage, but would not take any of the federal dollars offered under the Obama Administration.
Iowa – The Republicans recently unveiled a plan based on the Health Iowa initiative sponsored by Governor Terry Branstad (R-IA). Under the program, Medicaid will not be expanded, but an additional 89,000 Iowa citizens would be covered through other means.
Indiana – While advocates in the state legislature are calling for a proposed expansion of Medicaid, Governor Mike Pence (R-IN) continues with his opposition, noting that he’s concerned about whether or not the federal government will uphold its end of the bargain. Instead, he is proposing an expansion of the state’s Healthy Indiana Plan. The feds haven’t weight in yet on whether the plan would meet their specifications.
Ohio – Moody’s Investor Service recently released a report which noted that ” … failing to expand Medicaid under the federal health care law will put hospitals (in Ohio) at risk of budgetary shortfalls and put their bond ratings at risk.” Reaction in the state is mixed.
Missouri – The Missouri legislative is poised to take no action this year where the “Show Me” state is taking a “Wait and See” approach.
Arizona – Governor Jan Brewer (R-AZ) has proposed a Medicaid expansion program which is now being debated throughout the state. There is a clear divide based on party affiliation.
Tennessee – The Tennessee Health Care Campaign recently sponsored a rally in an attempt to urge Governor Bill Haslam (R-TN) to get a plan to the legislature before it adjourns. However, the Governor was unmoved by the advocacy group, and called for a proposed independent “Tennessee Plan.” The details are pending.
Oklahoma –Governor Mary Fallin (R-OK) announced her opposition to Medicaid expansion last fall, but the debate continues. Recently, Mike Crutcher, MD, the State Health Commissioner from 2003 to 2009, called for an expansion of the Medicaid program in Oklahoma. He said, “It is the morally and ethically right thing to do – to strive to provide health care to as many as Oklahomans as is absolutely possible.”
South Carolina – Governor Nikki Haley (R-SC) has been an ardent opponent of the Obamacare program. While there are proposals to expand Medicaid in South Carolina, they will not get the support of the Governor.