State Legislatures Quarrel Over Whether To Expand Medicaid

State Legislatures Quarrel Over Whether To Expand Medicaid

9:22pm May 14, 2015
Alaskans attend a rally in Anchorage for Medicaid expansion.
Alaskans attend a rally in Anchorage for Medicaid expansion.
Jonathan Casurella/Alaska Public Media

Five years after the Affordable Care Act passed, the law's provision allowing the expansion of Medicaid coverage to more people is still causing huge fights in state legislatures.

Twenty-four states and the District of Columbia said yes to Medicaid expansion when the law went into effect. Since then, just six more have signed on. States that say yes get billions of additional federal dollars, but many Republican lawmakers are loathe to say yes to the Obama administration.

The expansion enables adults with incomes up to 138% of the poverty level to receive Medicaid. The federal government picks up the whole tab for their care through 2016, then tapers its support down to 90% of the costs.

The fight's come to Florida and also out west, where four Republican-majority states took up Medicaid expansion this year. Wyoming said no. Alaska and Utah are still wrestling. Montana said yes.

Montana lawmakers have been stewing over Medicaid expansion since they said no to it in 2013, the last time they met. When they reconvened in January, Americans for Prosperity, a group backed by David and Charles Koch, staffed up in the state and targeted moderate Republicans, organizing anti-expansion town hall meetings in their districts.

But AFP didn't invite targeted lawmakers themselves, leading to a backlash. Many voters saw AFP's tactics as meddling by outsiders, and some AFP meetings were disrupted.

Lawmakers affiliated with the Tea Party in the Montana House fought hard against Medicaid expansion. They killed a proposal by Democrats, and then nearly derailed a Republican-sponsored compromise. The House had to bend its rules to even bring the bill to the floor for a vote. But in the end, 20 Republicans crossed party lines and voted with all the Democrats to pass it.

Still, at the bill's signing ceremony, state Sen. Ed Buttrey, a Republican who sponsored the bill, said, "This is not Medicaid expansion."

Buttrey says Republicans won important concessions from Democrats to make Montana's bill more palatable to conservatives. People will have to pay small premiums, and the bill also sets up job training and education programs. Buttrey insisted that Montana isn't just doing the bidding of the White House.

"I'll say it again, and I hope the media will report this exciting and unique story," he said. "This is not Medicaid expansion."

Montana's approach is now on its way to the federal government, which will have the last word on whether it's legal under the Affordable Care Act.

In Alaska, Gov. Bill Walker, a former Republican who is now independent, has made Medicaid expansion a top priority.

But Republicans leading Alaska's state House and Senate blocked expansion during the legislative session that just wrapped up.

One of them was state Sen. Pete Kelly. "I think everyone agrees that Medicaid is broken," he says. "To put more money into it, to bring more people into it, that's certainly not going to help its brokenness."

But 65 percent of Alaskans favor Medicaid expansion. Supporters testified in large numbers at legislative committee hearings and attended rallies. In one, organized by an interfaith church group, Lutheran pastor Julia Seymour turned the crowd into a choir. She led them in singing, "Medicaid expansion, I'm going to let it shine" to the tune of This Little Light Of Mine.

Even though the measure didn't pass this session, Seymour says she's more determined than ever to make sure all Alaskans have access to health insurance.

"The Bible tells us that faith, hope and love go on and do not end. And I'm keeping the faith and I am hopeful, but my love for some of the leaders is waning now and then," she says.

As soon as the regular session ended, Gov. Walker called lawmakers into special session but legislative leaders decided to take a recess.

The state is currently facing a massive budget deficit because of the plunge in oil prices. And Walker says even in better financial times, Alaska doesn't usually decline more than a billion federal dollars.

"If that was a road project or if that was some infrastructure project, we would be all over that," he says. "This is health care."

Walker has proposed expanding Medicaid on his own if lawmakers don't act, but it's not clear he has the authority. About 40,000 people would qualify for Medicaid if the state expands it and about 30 percent of this group are Alaska Native.

This story is part of a partnership with NPR, Montana Public Radio, Alaska Public Media and Kaiser Health News.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.

Transcript

STEVE INSKEEP, HOST:

We're about to listen to the still-evolving debate over Obamacare. That debate is changing, at least on the state level. It's become a bottom-line question.

RENEE MONTAGNE, HOST:

Many Republicans have vowed total opposition to the Affordable Care Act, but a slowly increasing number of states have decided to accept the law's federal help to expand Medicaid, the health insurance program for the poor. Five states with Republican-dominated legislatures have faced that question this year.

INSKEEP: In a moment, we'll hear the debate in Alaska. We start with the first state to pass a form of Medicaid expansion this year. Here's Eric Whitney of Montana Public Radio.

ERIC WHITNEY, BYLINE: Montana's legislature has been stewing over Medicaid expansion since lawmakers said no to it in 2013, when they last convened. When the session started this January, the Koch brothers group, Americans for Prosperity, staffed up here and targeted moderate Republicans, organizing anti-expansion town hall meetings in their districts.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED MAN #1: Well, that vote is a bellwether for Medicaid expansion forms. And so Rep. Gardner's on that vote on that to side with liberals...

WHITNEY: But AFP didn't invite targeted lawmakers themselves and that backfired. Many voters called AFP's tactics, meddling by outsiders, and some AFP meetings were disrupted. A reporter from the Flathead Beacon took this video.

(SOUNDBITE OF VIDEO)

(Booing)

UNIDENTIFIED MAN #3: Hey, hey, guys - hey.

WHITNEY: Tea Party lawmakers in the Montana House fought hard against Medicaid expansion. They killed a proposal by Democrats and then nearly derailed a Republican-sponsored compromise. The House had to bend its rules to even bring the bill to the floor for a vote. But in the end, 20 Republicans felt politically safe enough to cross party lines and vote with all the Democrats to pass it. But at the bill signing ceremony, Republican Senator Ed Buttrey, who sponsored the bill, said...

(SOUNDBITE OF CEREMONY)

SENATOR ED BUTTREY: This is not Medicaid expansion.

WHITNEY: Buttrey says Republicans won important concessions from Democrats. People will have to pay small premiums, and the bill also sets up job training and education programs. Buttrey insisted that Montana isn't just doing the White House's bidding.

(SOUNDBITE OF CEREMONY)

BUTTREY: I'll say it again, and I hope the media will report this exciting and unique story. This is not Medicaid expansion.

WHITNEY: Montana's proposal is now on its way to the federal government, who will have the last word on whether it's legitimate under the Affordable Care Act. For NPR News, I'm Eric Whitney.

ANNIE FEIDT, BYLINE: And I'm Annie Feidt in Alaska, where Governor Bill Walker, a former Republican who is independent, has made Medicaid expansion one of his top priorities. But Republicans leading the state House and Senate blocked expansion during the legislative session that just wrapped up. One of those opposed was Senator Pete Kelly.

(SOUNDBITE OF ARCHIVED RECORDING)

SENATOR PETE KELLY: I think everyone agrees that Medicaid is broken. Now, to put more money into it, to bring more people into it, that's certainly not going to help its brokenness.

FEIDT: Most Alaskans, though, favor Medicaid expansion. Supporters testified in large numbers at legislative committee hearings and attended rallies like this one, organized by an interfaith church group.

(SOUNDBITE OF RALLY)

PASTOR JULIA SEYMOUR: Is your light shining?

UNIDENTIFIED PEOPLE: Yes.

SEYMOUR: Are you willing to sing about it?

FEIDT: Lutheran Pastor Julia Seymour turned the crowd into a choir.

(SOUNDBITE OF RALLY)

SEYMOUR: For Medicaid expansion.

(Singing) For Medicaid expansion, I'm going to let it shine.

FEIDT: Even though it didn't pass this session, Seymour's more determined than ever to make sure all Alaskans have access to health insurance.

SEYMOUR: The Bible tells us that faith, hope and love go on and do not end. And I'm keeping the faith and I'm hopeful, but my love for some of the leaders is waning now and then.

FEIDT: Those leaders have another shot at passing Medicaid expansion. As soon as the regular session ended, Governor Walker called lawmakers into special session, but legislative leaders decided to take a recess. The state is currently facing a massive budget deficit because of the plunge in oil prices. And Walker says even in better financial times, Alaska usually jumps at the chance to accept more than a billion federal dollars.

GOVERNOR BILL WALKER: If that was a road project or if that was some, you know, infrastructure project, we'd be all over that. So this is health care.

FEIDT: Walker has proposed expanding on his own if lawmakers don't act, but it's not clear he has the authority. About 40,000 would qualify for Medicaid if the state expands. For NPR News, I'm Annie Feidt in Anchorage.

INSKEEP: That story is part of a reporting partnership with NPR News, local member stations and Kaiser Health News. Transcript provided by NPR, Copyright NPR.

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