Dive Brief:
- Among the GOP's questions as they tackle how to repeal and replace the Affordable Care Act will be what to do about Medicaid expansion, a major component of Obama's signature health law that has been implemented in 31 states.
- As with some other provisions of the law, simply rolling it back could prove politically perilous given that of the roughly 20 million people that obtained coverage under the ACA, about 12 million of those are low-income Americans now covered under Medicaid.
- The issue is also complicated by the fact some Republican governors expanded Medicaid, notably vice president-elect Mike Pence, who headed Medicaid expansion in Indiana, and Gov. Chris Christie of New Jersey.
Dive Insight:
Killing Medicaid expansion may not be an option, not only because of the impact to those it would displace from coverage, but because it could create a rift within the party between those who oppose it and those who have seen it benefit their states – and would presumably prefer not to be characterized as having erred in doing so.
Given those concerns, the matter is more likely to be resolved by some form of compromise in which Medicaid expansion continues to exist, but states get more freedom to design their programs as they please, some analysts say. That could mean a proliferation of conservative features such as co-pays and work requirements to more align the programs with the principle of personal responsibility.
Kentucky is currently seeking a waiver for a more conservative overhaul to its program (Gov. Matt Bevin is still in negotiations with federal officials), Arizona was granted one in September, and other states have expressed interest.
Among other possibilities:
- Arkansas' Republican Gov. Asa Hutchinson said this week he plans to resubmit a request (denied by the Obama administration) under the Trump administration to implement a work or work search requirement, according to Modern Healthcare.
- A resubmission could also be possible from Ohio, where Republican Gov. John Kasich was recently denied a request to drop adult beneficiaries, of any income level, who fail to pay into a health savings account, Modern Healthcare added.
- New Hampshire also recently had a waiver rejected under Democratic Gov. Maggie Hassan that would have required work and higher standards for proof of U.S. citizenship and state residency, The New York Times reported, suggesting it could try a new waiver under incoming Republican Gov. Chris Sununu.
Another possible scenario is that Trump and the GOP will follow through on the idea of turning Medicaid into a block-grant program, in which the federal government would give each state a lump sum to create their own programs, which opponents argue will cost states more or lead to major eligibility cuts.