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Map showing status of Medicaid expansion decisions in states as of 9/6/2013.

Map from The Advisory Board Company. Click on it to see it full-size.

While most of the attention at the moment is on the impending launch the health insurance exchanges under Obamacare, there are still states debating whether to take federal Medicaid expansion money, with potential to keep millions of people from remaining uninsured.

Surprisingly, Indiana and Oklahoma weren't immediate "no" states. The federal government has extended waivers that will allow them to use the expansion funds temporarily to allow more people to buy into their existing state-run programs. Neither state's programs meet the requirements Obamacare established for the Medicaid expansion, but the feds are working toward carving out space with these states for a version of Medicaid expansion that is acceptable to all parties.

In Ohio and Montana, voters might decide on expansion, since the legislatures have messed it up.

Fed-up expansion advocates are preparing to take their case to voters in Ohio and Montana, where Republican legislatures have stymied attempts to adopt expansion despite supportive governors.

If proponents successfully place the issue on the ballot, states may become magnets for outside interests warring over the health law. A 2014 ballot initiative in Ohio, in particular, could become a kind of swing-state audition for potential 2016 presidential candidates.

In Montana, the Medicaid expansion was blocked when one Democratic state lawmaker voted no—by accident—earlier this year. And barring an unlikely special session, the Legislature won’t convene again until 2015. So some Obamacare advocates want a ballot initiative to jump-start expansion. But it could also go the other way if outside opponents come in with open checkbooks.

More on Medicaid expansion below the fold.

The potential for the issue to go to the voters in Ohio, however, could still spur the legislature into action. It, along with Pennsylvania and New Hampshire, still has legislatures in session considering the expansion. Pennsylvania's Republican Gov. Tom Corbett is critical of, but open to, expansion, and would likely want to see some kind of deal or waiver to give the state more control. New Hampshire's Democratic Gov. Maggie Hassan supports the expansion, but the Republican state Senate has not. Even so, it convened a legislative commission to make recommendations, which are due in mid-October. That would give enough time for the issue to be voted on this session.

A handful of other states are in the nebulous "maybe" arena. Tennessee's Gov. Bill Haslam has been talking with the feds about some kind of waiver, but that's seemingly at a standstill right now. Utah's Republican Gov. Gary Herbert  has postponed making a decision until 2014, and even Republican governors in Wyoming, Idaho and South Dakota, who all turned down the expansion this year, say they are open to reconsidering next year.

In the purple states, the threat of this becoming a ballot issue for 2014 could spur action. It should become an election issue, whether on the ballot or in challenges to anti-expansion legislators and governors. There's no expiration date on the expansion, so states can sign up anytime, making this a potent issue. There are powerful lobbies in the health care industry who want to see the expansion, not to mention millions of Americans who would benefit by the coverage.

2:57 PM PT: Sources are reporting that Pennsylvania Gov. Tom Corbett has decided to accept the expansion, and will announce that next week.

Originally posted to Joan McCarter on Thu Sep 12, 2013 at 12:14 PM PDT.

Also republished by Three Star Kossacks.

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Comment Preferences

  •  Tip Jar (16+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Thu Sep 12, 2013 at 12:14:45 PM PDT

  •  What about Virginia? (2+ / 0-)
    Recommended by:
    hnichols, RANDREWF

    Do you think a win by McCauliff in the governor's race in Nov could spur them to do the medicaid expansion?

    "This ain't no party, this ain't no disco, this ain't no foolin' around..."

    by cgvjelly on Thu Sep 12, 2013 at 12:50:56 PM PDT

  •  Is Medicade expansion a one time deal? (0+ / 0-)

    Or can states agree to it in the future? I'm thinking if legislatures majorities switch parties could they enact the Medicaid expansion?

    A mind like a book, has to be open to function properly.

    by falconer520 on Thu Sep 12, 2013 at 12:54:45 PM PDT

    •  Yes, as I explain in the post, (1+ / 0-)
      Recommended by:

      they can agree to it in the future, so yeah, it should be a 2014 and 2016 issue.

      "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

      by Joan McCarter on Thu Sep 12, 2013 at 02:55:03 PM PDT

      [ Parent ]

    •  They can take the expansion anytime (0+ / 0-)

      However, the 100% federal funding is only available for the next couple years.

      Eventually the states are stuck with having to pay a whopping 10% of the costs themselves...

  •  ZOMG creeping Sociallizzum /nt (0+ / 0-)

    Warning - some snark may be above‽ (-9.50; -7.03)‽ eState4Column5©2013 "I’m not the strapping young Muslim socialist that I used to be" - Barack Obama 04/27/2013

    by annieli on Thu Sep 12, 2013 at 12:58:12 PM PDT

  •  Indiana's waiver... (1+ / 0-)
    Recommended by:
    Alexandra Lynch

    ...doesn't look all that hot:

    Unlike traditional Medicaid, Healthy Indiana caps the number of participants and the amount of care they can receive, does not cover all the services that Medicaid does, and requires cost-sharing from recipients. Pence argues that cost-sharing fosters personal responsibility and keeps costs down by giving patients an incentive to make smarter, cheaper, choices about care.
    Ugh, more "skin in the game" bullshit, this time for the poorest and sickest among us. I guess it's better than no Medicaid expansion at all, but I hate the fallacy that "consumers" are able to make "smarter choices" within a system that doesn't provide with price lists (and in which the real-life effect is to defer seeking medical care).

    It augurs poorly for the entire healthcare system, which now equates low-deductibles plans with Cadillac-driving welfare moms. (One of the reasons Labor is pissed, and passed the AFL-CIO resolution yesterday.)

  •  Oklahoma has extended (0+ / 0-)

    the Insure Oklahoma program for one year which is a limited form of health insurance for low income Oklahomans. The income threshold was lowered to 100% (previously 200%) of poverty level so a large number of people will still be kicked off the program.

    All Mary Fallin had to do was accept the Medicaid funding and 300,000 people would receive coverage but she cannot do that because she is a wholly owned subsidiary of big business and the Koch Brothers. This alternative is better than nothing but not much. It's unbelievable that so many people's lives have to be sacrificed to satisfy the false beliefs of the wingnuts. What a horrible cost in human suffering and death.

  •  What is the situation (0+ / 0-)

    of those people who were supposed to go into Medicaid in these states - what will happen to them, and how many people are estimated to be affected?

  •  Of all the things (1+ / 0-)
    Recommended by:
    Willa Rogers

    I am unhappy about in the ACA, the Medicaid expansion is top of the list.

    We should be getting rid of Medicaid, not expanding it. It was already a system in deep trouble without having millions more people dumped into it. We shouldn't have a cut-rate third-tier health care system for poor people. And especially not one that leaves those people at the mercy of state governments.

    Where the government is paying for care, there should be one level of care for everyone.

    •  I generally agree with you... (2+ / 0-)
      Recommended by:
      Alexandra Lynch, Kimbeaux

      ...that Medicaid serves as medical apartheid. At least PPACA raises provider reimbursement rates for Medicaid to parity with those under Medicare (although I think the funding is only provided for the first year).

      On the other hand, compulsory Medicaid might result in so many people enrolled in it that expanded Medicare becomes a reality through political pressure and demand.

      But the waivers for Indiana and Oklahoma appear to be pretty destructive: Oklahoma's further entrenches for-profit insurance and privatization by providing Medicaid recipients with vouchers for the federal exchanges (think Ryan plan for Medicare, only for Medicaid) and the Indiana waiver serves a fraction of those eligible for Medicaid under PPACA and requires cost-sharing from those least able to afford it.

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