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GOP's 'no' on Medicaid becomes "Let's make a deal'

March 24, 2013 @ 10:13 am


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JEFFERSON CITY, Mo. (AP) - Given the choice of whether to expand Medicaid under President Barack Obama's health care law, many Republican governors and lawmakers initially responded with an emphatic "no."

Now they are increasingly hedging their objections.

A new "no, but ..." approach is spreading among GOP states in which officials are still publicly condemning the Democratic president's Medicaid expansion yet floating alternatives that could provide health coverage to millions of low-income adults while potentially tapping into billions of federal dollars that are to start flowing in 2014.

The Medicaid health care program for poor, which is jointly funded by the federal and state governments, already covers about one in five people in the U.S. Expanding it was the way Obama envisioned covering many more low-income workers who don't have insurance. The new Republican alternatives being proposed in states generally would go part of the way, but cover fewer people than Obama's plan, guarantee less financial help or rely more on private insurers.

But so far, many of the Republican ideas are still more wistful than substantive. It's uncertain whether they will actually pass. And even if they do, there's no guarantee Obama's administration will allow states to deviate too greatly from the parameters of the Affordable Care Act while still reaping its lucrative funding. Yet a recent signal from federal officials that Arkansas might be able to use Medicaid money to buy private insurance policies has encouraged Republicans to try alternatives.

The GOP proposals could lead to another health care showdown between the White House and states, leaving millions of Americans who lack insurance waiting longer for resolution. Officials in about 30 states that are home to more than 25 million uninsured residents remain either defiant or undecided about implementing Obama's Medicaid expansion, according to an Associated Press survey.

Supporters of the Medicaid expansion have built coalitions of hospitals, businesses groups, religious leaders and advocates for the poor to try to persuade reluctant Republicans of the economic and moral merits of Obama's health care plan. But some Republicans believe the pressure ultimately will fall on Obama to accept their alternatives if he wants to avoid a patchwork system for his signature accomplishment.

"If the Obama administration is serious about innovative ways to bring down the cost of health care, it's going to cooperate with conservative ideas rather than continue down its one-size-fits-all, far-left-wing ideological path," said Missouri Rep. Jay Barnes, a Republican from Jefferson City.

A House committee led by Barnes already has defeated Obama's version of Medicaid expansion. It is to hear public testimony Monday on his "market-based Medicaid" alternative that would award health care contracts to competing private insurers and provide cash incentives to patients who hold down their health-care costs. His proposal would contain costs by covering fewer children than Medicaid now does and adding fewer adults than Obama's plan envisions.

Committees in Florida's Republican-led Legislature also have rejected a Medicaid expansion for roughly 1 million of the state's poorest residents, even though it is backed by GOP Gov. Rick Scott. Now Republican Sen. Joe Negron is pursuing an alternative that would use federal funds to provide vouchers for low-income residents to buy private policies. Negron said he still doesn't believe expanding Medicaid is the right decision, but he wants to help Florida residents get health coverage.

"We don't want to do it the Washington way. We want to do it the Florida way," Negron said.

Republican Ohio Gov. John Kasich also has been in discussions with the Obama administration about providing subsidized insurance instead of full Medicaid coverage for more adults. Republican governors in Texas, Nebraska and Indiana want the federal government to award Medicaid money as block grants to states.

"It's a two-step for many of these Republican governors. When they look at the numbers they want to do it, but they want to distance themselves from Obamacare at the same time," said Drew Altman, president of the Kaiser Family Foundation, a nonprofit that analyzes health care policies.

That might be fine with the Obama administration.

"There actually is quite a bit of flexibility on how they can approach this, and the federal government has indicated they want to get to `yes' " said Joan Alker, co-executive director of Georgetown University's Center for Children and Families in Washington, D.C.

As originally enacted, the Affordable Care Act required states to expand Medicaid to adults earning up to 138 percent of the federal poverty level, about $32,500 annually for a family of four. A Supreme Court decision last summer made the expansion optional for states but kept in place a powerful financial incentive. The federal government will fully fund the expansion for the first three years, with the states' share gradually increasing to 10 percent by 2020.

Health and Human Services Secretary Kathleen Sebelius said in December that getting full funding will still require a full expansion. Yet some Republicans in Missouri, South Dakota and elsewhere claim to see room for compromise.

LaTonya Jenkins, a 51-year-old laid off teacher's aide who lives in temporary housing for the homeless in Kansas City, recently enrolled in Medicaid but could lose coverage if her part-time job pushes her income over Missouri's strict eligibility limits. She recently traveled to Missouri Capitol to urge lawmakers to expand Medicaid.

"If they don't, and they cut it out, then what are we to do? We'll be lost," said a tearful Jenkins, who has diabetes and cares for her grandson. "I'll be sicker than ever and back in the hospital."

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Associated Press writer Kelli Kennedy contributed to this report from Miami.

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Follow David A. Lieb at: http://www.twitter.com/DavidALieb


(Copyright 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)
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Comments (13)


  • Add A Comment

  • SickofSeattleite wrote...
    and everybody knows what happened to the
    November 27, 2012 5:36 am
    TITANIC!
    { "Thumbs Up":"1","Thumbs Down":"-1" }
  • maplefish wrote...
    Think about this....
    March 24, 2013 9:38 am
    "Fathom the hypocrisy of a government that requires every citizen to prove they are insured... but not everyone must prove they are a citizen." Now add this, "Many of those who refuse or are unable to prove they are citizens will receive free insurance paid for by those who are forced to buy insurance because they are citizens."
    { "Thumbs Up":"1","Thumbs Down":"-1" }
  • SickofSeattleite wrote...
    everyone looses with Obamacare except the loosers who will get it free.
    November 27, 2012 5:43 am
    America can not afford Obamacare and neither can i.....average cost for a family of 4 .....$4-6 thousand a year and if you don't pay it the IRS will enforce the penalty fee of nearly $2,000 for not having coverage, that will be deducted from whatever you would have gotten back...next thing you know, you now owe the IRS plus penalty's and interest. How is this good for families like mine? (FYI the penalty for not having insurance the first year will only be about $200 per uninsured person.)No American is free when the owe the IRS. The only choice i would be able to afford would be to pay to not have coverage. How is this fair? Obama has made it a law to FORCE you to BUY a health care plan approved by the GOVT or you will be FORCED to pay a fine or sent to JAIL. Here's the kicker, the royal politicians will be exempt because they are special and require far superior care than the average struggling American.
    { "Thumbs Up":"1","Thumbs Down":"-1" }
  • maplefish wrote...
    It's a lose lose proposition
    March 24, 2013 9:20 am
    OBAMACARE is going to be a disaster. Its already estimated by the CBO to be $2.8 TRILLION over what Obama promised it would cost....Doctors will start taking retainers, like lawyers. The majority of physicians will stop seeing Medicare recipients because they will lose money. Plain & simple. Government comparative-effectiveness boards will dictate how doctors practice medicine. Which will cause doctors to leave the field, leading to a severe shortage of doctors.. The ich will still be able to afford whatever coverage they want. The poor ill continue to get FREE healthcare and the costs will be passed on to the middle class. Do the Math. It's a HORIBLE IDEA!!!
    { "Thumbs Up":"1","Thumbs Down":"-1" }
  • wsualumn wrote...
    OBAMACARE
    March 24, 2013 9:52 am
    Help me out critics. This plan was first introduced by The Heritage Foundation(conservative based) in 94 and endorsed by many GOP politicians. Romney implemented this system in Massachusetts and said it was a model for others to follow. Now I listen to Hannity and other critics talk about how it kills business. Doesn't business pass the cost of this to the customers to cover their end of the cost? It's like when I hear many of the conservative pundits talk about how high taxes hurt business and then I will later hear them say that they don't pay for those taxes, it's the customers who pay for those taxes because the businesses just pass those costs onto the customers. It's very interesting to hear them say one thing and then later contradict themselves as well.
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  • maplefish wrote...
    WSU
    March 24, 2013 12:05 pm
    There were huge differences in Romney's plan. And it still doesn't make it a good idea. I suggest you look at the cost associated with what ALL the Hospitals in this country use. It's known as the Master Chrge List. We need to start right there and work backwards. This is the list that hospital s use to gauge charging $5.00 for 1 tylonal. Or $3.00 for a bandage. Somewhere these costs have got to be addressed. I'm all for the free market, but if this it what is being charged now, just think what will happen once Obama Care kicks in. Ith is truly will destroy the country.once the government controls our healthcare, they will be able to control when we live or when we die. Socialized medicine in other countries is a joke! Look at Canada...
    { "Thumbs Up":"1","Thumbs Down":"-1" }
  • wsualumn wrote...
    MAPLE
    March 24, 2013 12:47 pm
    Thanks for the info. Do you know what the huge differences were in Romney's plan? I have heard that this plan is completely different and have heard it isn't that much different. I don't know what the real answer is. I have actually heard good and bad points about the medicine plans in Canada and Europe. It's actually the most effective way to run the system. If you look at life expectancy in those areas, many are doing better than we are. We have to be honest, our system has its issues without Obamacare.
    { "Thumbs Up":"1","Thumbs Down":"-1" }
  • wsualumn wrote...
    Meant To Say
    March 24, 2013 12:57 pm
    It is the most "cost effective way" to run healthcare. The costs for bypass surgeries and hip replacements in those countries are much less expensive and hospital stays are cheaper too. I know there is the waiting list and you get bumped up if you are in worse shape than others. My mom's friend lives in Norway and she had a hip replacement last summer. She is from here, but now lives in Norway. She likes their single payer system. Like I said, I am sure there some that like it and that don't. One of the good things about single payer is that the business doesn't have to cover healthcare costs anymore. That takes a problem off of their back. I honestly believe that we will eventually go to a single payer program.
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  • maplefish wrote...
    Ahhha Yes, the waiting lists...
    March 24, 2013 1:10 pm
    And that's where we're going to run into bureaucratic nightmares. Especially as the boomers age. As for Ronmeys plan I honestly don't know all the particulars, but I do know it wasn't nearly as complicated and overreaching as Obamcare is proving to become. It's a beast. Think about it this way, if the head of the CIA doesn't know all of the rules and regulations and everything that's going on under his watch in all the different departments, just think how complicated this debacle is going to be? And they still don't evn know how it's going to be implemented? The only thing ANYBODY KNOWS FORESURE is its going to be extremely expensive on the middle class. And if you blow your knee out skiing at Whistler, you better hope to do you can come to the US to get surgery, otherwise, you're probably not going to be walking for years....TRUE STORY I have a Canadian friend that is still enduring this misery.
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  • maplefish wrote...
    Very True
    March 24, 2013 1:22 pm
    The thing that anyone in their right mind should really be afraid of, are the words of Nancy Polosi: " we'll find out what's inside the bill, AFTER, we sign it into law". That pretty much says it all....why do Democrats think that just pissing away as much of the taxpayers money as possible, should just be accepted??? WSU- would you sign a contract for something without any idea of what it was really going to cost you? I would think not. So why is it OK for our government to o that with our money? And with ZERO ACCOUNTABILITY ?
    { "Thumbs Up":"1","Thumbs Down":"-1" }
  • wsualumn wrote...
    Maple
    March 24, 2013 2:00 pm
    Hang on a minute. That Pelosi quote isn't fact. It is the edited version. Go to fact check and you can see what the entire quote was. That was edited and continues to be played. That doesn't mean I am a Pelosi fan either. There are so many bills that signed into law and nobody knows the entire fact sheet. No Child Left Behind, The Patriot Act, Medicine For Seniors, etc. The politicians that sign those bills don't know a lot of the info. They know many of the so called "bullets" of the bill. The bills are so lengthy it is impossible for them to digest all of the info. When I signed my mortgage contract and had to initial all of the pages, I knew very little about all of the details. My health insurance plan is also one that I don't entirely understand. I sometimes have to call a representative to ask a question.
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  • maplefish wrote...
    WSU
    March 24, 2013 9:46 pm
    The Polisi statement is a FACT! I watched it LIVE when she said it and almost fell out of my chair! Don't try to sugar coat it. Just like Obama saying "you didn't build that". Why on earth do you Democrats always try to deny or twist the actual statements that your leaders make? Please, explain this statement and tell me where I'm missing the facts??? www.youtube.com/watch?v...autoplay=1 why do you continually cover for the liars in this administration???
    { "Thumbs Up":"1","Thumbs Down":"-1" }
  • maplefish wrote...
    WSU- please tell me what FACT i'm missing
    March 24, 2013 9:50 pm
    www.youtube.com/watch?v...autoplay=1
    { "Thumbs Up":"1","Thumbs Down":"-1" }
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