More on 2015 Medicaid Expansion

A quick update from the post earlier this week on potential Medicaid expansion in 2015.

  • Healthy PA was approved yesterday with a launch date of 1.1.15.
  • Tennessee is making noises about seeking a waiver along the lines of either  Healthy PA or the Arkansas private option model.  Tennessee has the local examples of Kynect in Kentucky and Arkansas so the special snowflake excuse does not fly.

The Tennessean reported that Gov. Bill Haslam (R) said Thursday that Tennessee would aim to submit a Medicaid expansion plan to the Department of Health and Human Services “some time this fall.” The program would cover more than 150,000 low-income residents in the state…

Haslam has floated a “private option” plan, using Medicaid dollars to pay for private coverage, as has been done in Arkansas and Iowa. Other pieces of the Tennessee plan could include co-payments and incentives for healthy behavior, based on the governor’s past public comments.

  • Utah is doing something about expansion.  The goal is to get a plan to the state legislature this fall.  The extremes of the debate is hope that charity care will be sufficient to solve the uninsured and underserved problem (if it was, Obamacare never would have been needed) to a private option waiver.  The big challenge is Utah wants a work requirement and HHS won’t tie work to medical care.  HHS shot down the same type of requirement with Healthy PA, so they will continue to shoot it down in Utah.   
  • My read on Virginia is that if Arkansas can cobble together a 75% supermajority with large Republican majorities, Virginia can find 20% of the Senate Republican caucus and 40-50% of the House Republican caucus to defect for the good guys on this one.  I could be totally wrong, but that is how my read is being informed.

My gut feeling is that there will be another three or four states that will want to get a waiver application in sometime between December and March of next year for launches by 9/1/15 as the political window is open for apostate Republicans to avoid getting primaried.






24 replies
  1. 1
    rikyrah says:

    Thanks for keeping us updated.

  2. 2
    Baud says:

    No rush. The people can wait.

  3. 3
    OzarkHillbilly says:

    Which will be the last state to expand Medicaid? Texas, Louisiana or Mississippi? My money is on Oklahoma.

  4. 4
    shelley says:

    @OzarkHillbilly: Don’t forget Christie’s New Jersey. Can’t piss off the base if he still has ’16 aspirations. (They still blame him being nice to Obama, for Romney’s loss.)

  5. 5
    Ken says:

    that charity care will be sufficient to solve the uninsured and underserved problem (if it was, Obamacare never would have been needed)

    IIRC the same argument is regularly made about hunger programs. Then during the shutdown, it turned out that most charity food banks were getting upwards of 80% of their food from federal programs, since the private donations are way too little to cover the need.

  6. 6
    mb says:

    I am an impoverished, male, 50-something, Mississippian — so, no access to health insurance. I am watching with interest, and not a little trepidation, this movement toward sorta, kinda, implementing medicaid expansion. So far, I think I’d rather have what I have, i.e., nothing, than the bullshit programs that are being kludged together in these new expansion states. I’m sick of programs that perpetuate the stupid system we have. I spent 30 years working in healthcare and I am not a fan of either the delivery system or the payment mechanisms.

    Are these new expansions going to help some folk? No doubt and good for them. But my life is complicated enough without more bullshit. Setting up these Rube Goldberg payment mechanisms is not just stupid but cruel. Give poor folk a few more hoops to jump through — that’ll fix ’em. No doubt.

    Fortunately, my governor is, according to him, led by the Holy Spirit. Which is to say, he’s so stupid he is lucky to find his way out of the shower stall each morning. So I don’t expect any fancy “market solution” to my healthcare needs in the near future. But he won’t be around forever.

  7. 7
    Davis X. Machina says:

    @shelley: In April we had a Republican governor veto a Republican bill (with bipartisan support) to get into the Medicaid expansion thing. And Landslide LePage isn’t running for President.

    LePage’s veto Wednesday marks his third rejection of the expansion. The measure he vetoed was billed as a bipartisan compromise and introduced by two moderate Republicans, Sens. Roger Katz, of Augusta, and Thomas Saviello, of Wilton. Their participation, along with Republican-friendly provisions for cost management, were designed to garner support from their caucus. However, Republican opposition stiffened.

    Note how the opposition stiffened…. It really is all down to “Just how big a dick do you want to be…?”

  8. 8
    Matt McIrvin says:

    The sad thing is, LePage will almost certainly be reelected because of a split opposition _again_.

  9. 9
    RaflW says:

    The data on plunging charity care expenses at opt-in state’s hospitals must be making GOP lawmakers ill. I’m sure the pressure from hospital associations and boards is intense. Good. The stand these Repubs took was immoral in the extreme, and a stupid waste of money to boot!

  10. 10
    JPL says:

    @OzarkHillbilly: What about GA? The Governor doesn’t have the authority to expand Medicaid without the full consent of the state senate. It will never happen.

  11. 11
    RepubAnon says:

    A work requirement for health insurance? What if your current health status means that you’re too sick to work?

    This is, after all, one of the reasons why employer-based health care was popular with insurers… it helped cherry-pick healthy people from the overall population by excluding folks that missed too much work due to illness.

    What vile, evil, self-righteous folks these right-wingers are.

  12. 12
    MomSense says:

    @Matt McIrvin:

    It is soooo frustrating. In my phone calling the response is back to the I’m waiting to see which one looks more likely to win at the end of the campaign–which pretty much guarantees that they are both in until the end of the campaign.

  13. 13
    Jeremy says:

    @Matt McIrvin: Not really ! Even in a three way race the democrat has been ahead in the majority of polls. Things could change but Lepage is in trouble.

  14. 14
    qwerty42 says:

    Georgia has done its best to prevent anything like this from happening, even if the Democrat (Carter) wins the governorship. However … Rural and small town hospitals all over the state have closed (Elberton, GA the most recent) or are in danger of closing. They need the money. The rural areas are usually red, (urban – Atlanta, Savannah – blue, suburbs vary). The suburbs are not hurting this way, and the rural areas have this “traditional” mindset which tends to make them conservative … right up until they aren’t. Once upon a time, their grandparents grew up in a house with two pictures: Jesus and Franklin Roosevelt. At some point, the rural folks will figure out the suburban Republicans are not actually their friends. Well, that and the demographic change working its way through the state. Ummm… I’m rambling here, but the docs and local folks are going to want this changed.

  15. 15
    notorious JRT says:

    @Matt McIrvin:
    But, Jim Fallows is pals with Elliot Cutler. So Maine has that going for it.

  16. 16
    Davis X. Machina says:

    @Matt McIrvin: Tell that to Cutler voters. Oh, wait, you can’t.

    They’re above politics.
    It’s all so… tawdry and low.

    @notorious JRT:

    James Fallows is so far above politics that he needs imaging specialists from the National Reconnaisance Office to point it out in the aerial photographs.

  17. 17
    Woodrowfan says:

    I think you’re wrong on Virginia. The repubs that run the House, and will control the Senate now after a special election, tend to vote in lockstep. And the teamorons now run the republican party here. I hope I am wrong but I am pessimistic enough to think Mississippi will expand about the same time we do.

  18. 18
    Davis X. Machina says:

    @Jeremy: Most recent poll was a Democratic one, and it had Michaud +2, well within the MoE.

    LePage voters will crawl over broken glass to get to the polls, too.

  19. 19
    Woodrowfan says:

    LePage voters will crawl over broken glass to get to the polls, too.

    And blame Obama for their cuts.

  20. 20
    hells littlest angel says:

    It was so generous of Gov. Corbett to cave on Medicaid expansion at this time. When it takes effect in January, it will make things quite a bit easier for Gov. Wolf.

  21. 21
    hells littlest angel says:

    @Davis X. Machina:

    LePage voters will crawl over broken glass to get to the polls, too.

    Hey, I’ve got some glass!

  22. 22
    RSA says:

    @Ken: On that same topic, in 2012 (the latest year I could find common numbers for) American individuals and organizations gave $316 billion to charity. That’s a lot! But in 2012 healthcare spending was $2.8 trillion; $316 billion (all charity) adds just 11% more. Is the argument that a much, much smaller boost than 11% will somehow reduce the cost of healthcare for around 15% of the population that’s uninsured? I’m not seeing how.

  23. 23
    mattH says:

    Yay Utah, bet they’ll be the last.

  24. 24
    Chris T. says:

    @mattH: Oddly enough, Utah does very well on the whole charity thing (food, medical care, etc)—or it may not be all that odd after all, because the Mormon church was an extremely social1st institution. Back when Brigham “Bring-em-” Young and that crowd first settled by the Great Salty Lake, if you were a follower, you quite literally gave all your property to the church, and the church then redistributed the wealth according to its (or Young’s) dictates.

    That communistic aspect of life is still there, but has been watered down to the 10% (tithe) factor: you keep 90% of what you earn—there is a lot of debate, apparently, as to whether this is gross or net, before or after taxes—and the church is only 10% soc1alist. Anyone (even non-church-members) may make use of the pooled resources, although those making use are expected to give back in some way—e.g., if you use their charity food, according to your need, you’re supposed to help cook or clean or whatever, according to your ability.

    Point these facts out to any die-hard Mormon, though, and they tend to want not to listen, for some reason. :-)

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