New momentum for Medicaid expansion, as more Republicans conclude Obamacare won't get repealed
By James Hohmann
March 28 at 10:59 AM - The Washington Post
THE BIG IDEA: Paul Ryan promised his donors yesterday that he will
keep pushing to overhaul the health care system this year, despite his failure
last week. But in the 19 states that never expanded Medicaid
under the Affordable Care Act, the calculus has quickly changed.
A lot of state legislators, including Republicans, are putting more stock in
what the Speaker said Friday, that Obamacare will be the law of the land for the
foreseeable future.
The bill that was being considered in the House would have phased out the
expansion under the 2010 law, which has already grown the Medicaid rolls by more
than 11 million people. It could have left states holding the bag over the next
couple of years.
With Obamacare repeal less likely, opponents of expansion in the states have
just lost their best argument.
-- The Kansas Senate voted last night to expand Medicaid, which would
mean coverage for 150,000 currently uninsured Kansans. Senators cleared
a procedural hurdle by a vote of 25-13. There will be a final vote today.
Republican Gov. Sam Brownback has signaled a likely veto, but hefs also expected
to soon get appointed to an overseas posting by President Trump. So the
legislature might be able to try again soon.
gThe failure of the federal effort to repeal the Affordable Care Act
hung over the debate,h the
Wichita Eagle reports of the floor fight. gElections last fall
swept a number of moderate Republicans and Democrats into (state) office, giving
supporters of expansion a boost. c The House already passed the bill 81-44. The
House vote and the initial Senate vote are just shy of the number needed to
override a veto. Override takes 84 votes in the House and 27 votes in the
Senate.h
-- In Georgia, Republican Gov. Nathan Deal announced yesterday that
his administration is exploring changes to the statefs Medicaid program now that
the House bill has gone down. A former congressman, he said hefll get
with HHS Secretary Tom Price, who hails from Georgia, about what kind of waivers
the state might be able to get now to sweeten the deal. gWe will be looking at
those possibilities,h Deal said at a press conference. gWe have not formulated
any proposal at this time, but the waivers will be primarily restricted to our
Medicaid program.h
gGeorgia lawmakers in 2014 passed legislation that gives the Legislature the
final say over any expansion to the Medicaid program,h the
Atlanta Journal Constitution explains. gGeorgia flirted with a wide-ranging
waiver in 2015 under Barack Obamafs administration that would have sought more
Medicaid money to help the statefs struggling rural hospitals and its big
esafety netf hospitals like Grady Memorial in Atlanta. But the state later
quietly abandoned those discussions.h
-- In Virginia, meanwhile, the failure of Congress has emboldened
Democratic Gov. Terry McAuliffe to renew his stalled crusade to expand
Medicaid. Yesterday he proposed an amendment to state budget language
to give him power to set an expansion in motion, and called on the
Republican-controlled General Assembly to immediately begin making plans.
Republican legislators were unmoved by the plea, saying they would reject the
amendment and that they stood firm against expanding Medicaid. But it ensures
that Medicaid expansion will now be a top issue in this yearfs open
gubernatorial contest. (Gregory
S. Schneider has more.)
-- Forbes Magazine says to keep an eye on other places like North
Carolina, which now has a Democratic governor. gAnd there may be even
more states that will resurrect state legislative efforts to expand Medicaid.
Before Trump was elected c Idaho, Nebraska and
South Dakota were considering expansion,h notes
Bruce Japsen. Legislators stopped debating expansion in those places when it
seemed like the ACA would be repealed.
gIn Maine, GOP Gov. Paul LePage has vetoed several bills to expand Medicaid
passed by the statefs Democratic-controlled legislature, most recently last
year. But Mainers will get a chance to vote on expansion in a referendum
this November,h the
Huffington Post notes.
-- A robust debate over Medicaid is playing out this week in
Arkansas, as well. gAn effort to continue the hybrid Arkansas Medicaid
expansion another year failed (last night) in the state Senate,h the
AP reports from Little Rock. gThe budget bill for the state's Medicaid
program and the expansion failed on two votes. c Legislative leaders said they
planned to try again with the proposal on Tuesday, and were confident they had
the votes needed. The top Republican in the Senate said he didn't
believe the program would be blocked while the future of the federal health law
remains in limbo. eI don't think there's sufficient will right now to
start blocking budgets when we don't even know what's going to happen or how
long it's going to take,f Senate Majority Jim Hendren said after the votes.h
More than 300,000 people are on Arkansas' hybrid program, which uses Medicaid
funds to purchase private insurance for low-income residents.
-- Once Medicaid is expanded, it is politically very hard to take
coverage away from people. Key opponents of the House GOP bill, for
example, included Michigan Gov. Rick Snyder and Ohio Gov. John Kasich, two
Republicans who chose to expand Medicaid. A lot of the House moderates from the
Tuesday Group who helped torpedo the bill hailed from expansion states and did
so because they were concerned about Medicaid recipients in their districts
getting hurt.
-- The New York Times has a
good story on its front page today about how the health care fight last week
showed the degree to which Medicaid has come of age: gWhen it was
created more than a half century ago, Medicaid almost escaped notice. Front-page
stories hailed the bigger, more controversial part of the law that President
Lyndon B. Johnson signed that July day in 1965 — health insurance for elderly
people, or Medicare, which the American Medical Association had bitterly
denounced as socialized medicine. c But over the past five decades,
Medicaid has surpassed Medicare in the number of Americans it covers.
It has grown gradually into a behemoth that provides for the medical needs of
one in five Americans — 74 million people — starting for many in the womb, and
for others, ending only when they go to their graves.h
Some remarkable figures: gIn 2015, the nation spent more
than $532 billion on Medicaid, of which about 63 percent was federal money and
the rest from the states. c Medicaid now provides medical care to four out of 10
American children. It covers the costs of nearly half of all births in the
United States. It pays for the care for two-thirds of people in nursing homes.
And it provides for 10 million children and adults with physical or mental
disabilities. For states, it accounts for 60 percent of federal funding —
meaning that cuts hurt not only poor and middle-class families caring for their
children with autism or dying parents, but also bond ratings.h
-- Speaking to his donors on a conference call, Ryan insisted that
the House got pretty close to passing his bill. gBasically c 90 percent
of our members of the conference were there and ready to go and be a governing
party and were happy with where we were, and around 10 percent were still in
what I would call eopposition party mode,fh Ryan said on the call, an audio
recording of which was obtained by The Post. gAbout 10 percent of our people, a
particular bloc, just werenft there yet, even with the presidentfs
involvement.h
Ryan said he intends to work gon two tracksh as he pursues other
elements of Trumpfs agenda at the same time he keeps working on health
care. gWe are going to keep getting at this thing,h Ryan said on the
call. gWefre not going to just all of a sudden abandon health care and move on
to the rest. We are going to move on with rest of our agenda, keep that on
track, while we work the health-care problem.h
Ryan did not disclose details of what the next iteration of the bill
might look like, but he suggested that a plan was being developed in time to
brief the donors at a retreat scheduled for Thursday and Friday in
Florida, according
to Mike DeBonis.
-- Former Rep. Tom Davis (R-Va.), who twice chaired the NRCC, warns
in an
op-ed for The Post today that Republicans could lose the House if they donft
quickly get their act together: gUnless the current trajectory is
reversed, the Trump administration faces a difficult midterm that could undo its
agenda and put House gavels and subpoena power in Democratic hands. c The
collapse of the Republican health-care bill was a massive case of legislative
malpractice. But playing the blame game and pointing fingers does little to
advance the ball. c There is time to recover from a difficult start. This will
entail compromise and, in some cases, working with Democrats to get half a loaf.
But your fumbling of health care puts you in a weakened bargaining position and
your internecine fighting dispirits the party base. As James Bondfs nemesis
liked to say, eChoose your next move carefully, Mr. Bond, it may be your
last.fh
-- But Republican strategists and elected officials are deeply
divided over the best path forward. The
Times's Jonathan Martin talked to players on both sides of the
debate—
The case for moving on: gWefve got a lot of time to do real
things on infrastructure, to do real things on tax reform, on red tape reform,
and really get the American economy moving,h said Rep. Steve Stivers (R-Ohio),
the current chairman of the NRCC. gWe do those things and we still have a lot of
time to recover. c If youfre going to fumble the ball, better to do so in the
first quarter of a football game. c I think we need to start negotiating with
Democrats instead of the Freedom Caucus. They donft know how to get to yes.h
Even if leadership tried and Trump re-engaged, itfs not clear they
could get it done: gNot unless Harry Houdini wins a special election to
help us,h said Rep. Billy Long (R-Mo.).
The case for circling back: gWhat troubles many Republican
strategists is the specter of the partyfs most reliable voters being bombarded
by reminders of their leadersf failure to address the health law. They fear a
recurring story line sure to pop up every time insurance premiums increase,
providers leave local networks, or, most worrisome, Republicans fund Barack
Obamafs signature achievement. Conservatives c now warn that it is untenable to
stand pat on the issue — and that lawmakers will face retribution if they do not
return to the repeal-and-replace effort. eIf people are looking at a
situation where therefs no action on this, there are going to be conversations
about primaries,f warned Michael A. Needham, the chief executive of Heritage
Action for America c which worked to scuttle the c bill last week.h
-- John Cornyn, the number two Republican in Senate leadership, said
flatly that health care will not be attempted again via the budget
reconciliation process. "It's clear it needs to be done on a bipartisan
basis,h the Texan told the AP.
-- Trump, for his part, tweeted last night that hefll come back to
the issue gas soon as ObamaCare foldsh:
-- Greetings from spring training in West Palm Beach, Fla.
The Nationals were in great form against the Mets yesterday. Bryce
Harper and Trea Turner each homered twice, and Washington beat New York 6-0. The
game showed why all the handicappers think the Nats will win the NL East again.
The most memorable moments in Port St. Lucie were when Max Scherzer kept striking
out Tim Tebow, the Heisman-winning quarterback who fizzled in the NFL and
now wants to be a pro baseball player. Tebow was no match for our Cy Young
winner, one
of the best pitchers in baseball, who clearly relished the match-up. Then my
dad and I drove down A1A and enjoyed some delicious Cuban food.