At least seven Republican governors have had a change of heart on expanding Medicaid, a key part of President Barack Obama’s healthcare plan to insure an additional 30 million people.
According to The New York Times
, governors are coming down on the side of expansion in Arizona, Michigan, Nevada, New Mexico, North Dakota, Ohio, and Florida, where Gov. Rick Scott did an about-face on Wednesday to announce his support for expanding Medicaid.
Scott, a former hospital executive, has been one of the strongest critics of the healthcare law, making his opposition a key component of his 2010 gubernatorial campaign.
“I think this means the dominoes are falling,” Ronald Pollack, the executive director of Families USA, told the Times. “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.'”
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Under the new healthcare law, expanding Medicaid to many more low-income residents is an option but not a requirement, so it is up to individual states to decide for themselves.
The federal government will pay the full cost of covering those who are newly eligible from 2014 to 2016, and will cover 90 percent or more after that.
But many Republican governors and legislators have questioned both the level of commitment at the federal level and the logic of increasing spending on Medicaid at a time when lawmakers are struggling to balance the budget.
The change in stance by some GOP governors comes after heavy lobbying by proponents of expanding Medicaid, who say that in addition to saving lives, it would create jobs and stimulate the economy. For weeks, state hospital associations and advocates for the poor have been issuing studies to that effect, according to the Times.
Such studies have reportedly been issued in Idaho, Indiana, Mississippi, Missouri, Texas, Virginia, and Wisconsin. Publication of similar studies in Ohio by respected schools and institutions was “a major watershed moment” for the debate, Ari Lipman, chairman of the Northeast Ohio Medicaid Expansion Coalition, told the Times.
He said the studies helped advocates in that state reframe Medicaid expansion as something that would help the state budget and the state economy, while providing health insurance to more than 455,000 people by 2022.
Ohio GOP Gov. John Kasich recently decided to expand Medicaid in his state.
Nationwide, Medicaid covers 60 million low-income or disabled people, and the Congressional Budget Office has estimated that 17 million more could be enrolled if all 50 states opted to expand the program.
Some Republican governors who have changed their minds on expanding Medicaid may also have been swayed by politics. Obama won five out of the seven states where governors have reversed their stands against expansion and some of those governors are up for re-election next year.
In some states, including Arkansas, religious groups are appealing to state officials to expand Medicaid.
Arizona Gov. Jan Brewer, who has fought on a variety of issues, had her own reason for deciding to recommend Medicaid expansion. If a state does not expand the program, she explained last month, U.S. citizens won’t be able to obtain health insurance while some legal immigrants with the same income could get it.
“For poor Arizonans below 100 percent of the federal poverty level, only legal immigrants but not citizens would be eligible for subsidies,” she said.
Still, some GOP governors are not willing to budge from their opposition to expanding the program. South Carolina Gov. Nikki Haley is one of them.
“As long as I am governor, South Carolina will not implement the public policy disaster that is Obamacare’s Medicaid expansion,” she said in her State of the State address this year.
And Texas Gov. Rick Perry said his state won’t expand the program, and will not follow other states “scrambling to grab every tax dollar they can.”
So far, 22 states have plans to expand Medicaid, 17 have said they will not, and 11 remain undecided, according to the consulting group Avalere Health.
Those numbers could change. In many states, Medicaid expansion is subject to legislative approval, and many Republican lawmakers are not yet convinced it is the right thing to do.
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