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.More on Medicaid expansion below the fold.
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.
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.