Medicaid expansion

The New York Times' Abby Goodnough reports that Temple University Hospital in Philadelphia and other hospitals serving poor neighborhoods face a financial crisis if the Affordable Care Act is repealed. President-elect Donald Trump and Republican Congressional leadership have vowed to do exactly that.

The hospital industry predicts that "hospitals stood to lose $165 billion through 2026 if more than 20 million people lose the insurance they gained under the law. They predicted widespread layoffs, cuts in outpatient care and services for the mentally ill, and even hospital closings."

Prior to the Affordable Care Act, the hospitals had to absorb the cost of caring for uninsured patients. Hospitals who serve a large number of poor and uninsured patients also agreed to funding cuts in exchange for getting more patients with Medicaid and other insurance coverage. If Medicaid expansion is rolled back, hospitals like Temple are hoping that supplemental funds to defray the costs of caring for the uninsured will be restored.

The expansion of Medicaid under the Affordable Care Act has lowered the burden of medical debt for some low-income consumers, according to a study from the National Bureau of Economic Research. The study looked at the medical-debt collection balances referred out to debt collectors in areas with high populations of low-income patients. The study's authors' estimates "'imply a reduction in collection balances of around $600 to $1,000 among those who gain Medicaid coverage.'"

A showdown between bitter opponents of the Affordable Care Act and Republican Governor Asa Hutchinson has resulted in the state preserving its expansion of Medicaid, AJMC's Mary Caffrey reports. As a result, Medicaid will continue for 267,000 residents who earn up to 138 percent of the federal poverty level. The expansion includes a waiver from the Centers for Medicaid and Medicare Services with provisions to require "more personal responsibility."

Kentucky Democratic legislators have passed legislation to try to maintain that state's Kynect health care exchange and its Medicaid expansion, the Courier-Journal's Tom Loftus reports. However, the legislation doesn't have a chance of passing the Republican-controlled state Senate.

Republican Governor Matt Bevin is doing away with Kynect and shifting to the federal healthcare insurance exchange. Bevin is also asking for a waiver from federal regulators for how Kentucky runs its Medicaid expansion.

An Alaska judge has ruled that state's governor had the authority to expand Medicaid, without legislative approval, to cover people between the ages of 19 and 64 who are not caring for dependent children, not disabled and not pregnant, and who earn up to 138 percent of the federal poverty level, The Associated Press' Becky Bohrer reports. 

Legislators argued that the group is not a mandatory group to be covered under Medicaid. The judge, however, ruled that state law needs to be changed for that population not to have to be covered.

Wyoming legislators have rejected the expansion of Medicaid to 20,000 low-income Wyomingites, The Wyoming Tribune Eagle's James Chilton reports. Most legislators continued their opposition to the expansion, but Sen. Tony Ross, the chairman of the Senate Appropriations Committee, changed his mind "having looked at the potential savings and compared them to the state’s massive looming budget shortfalls." However, not enough legislators changed their mind to bring Medicaid expansion to Wyoming.

Virginia Democratic Governor Terry McAuliffe once again suggested Virginia expand Medicaid in his latest budget proposal, but House Republican leaders immediately rejected the plan, the Richmond Times-Dispatch reports. The plan would have used a tax on hospital revenues to generate Virginia's share of the costs of the expansion.

An Arkansas legislative task force has backed Gov. Asa Hutchinson's efforts to get federal waivers from some rules for Medicaid, The Times Record's John Lyon reports.

Hutchinson wants waivers like requiring people with incomes of 100 to 138 percent of the federal poverty level to pay premiums and referring "unemployed, able-bodied beneficiaries" to work training before he would agree to maintain the Medicaid expansion that provides health insurance to more low-income Arkansas citizens.

The current Medicaid waiver that allows federal dollars to subsidize private health insurance is going to expire at the end of 2016.

South Dakota Republican Governor Dennis Daugaard and conservative Louisiana Democratic Governor-Elect John Bel Edwards have come out in favor of the expansion of Medicaid in their states.

JR Ball, a columnist for Nola.com | The Times-Picayune, notes that Louisiana is on track to become the second state in the Deep South to adopt Medicaid expansion. Republican legislators, who control the Louisiana Legislature, have sharply reversed course, now favoring expansion now that there is a change in guard about to take place between Governor Bobby Jindal and Governor-Elect Edwards.

In South Dakota, Daugaard has pitched a plan to expand Medicaid to 55,000 low-income residents, The Huffington Post's Jeffrey Young reports. The governor said that expansion would cost less than what South Dakota expends for health care services American Indians receive outside of the Indian Health Service.

Alabama Governor Robert Bentley, a conservative Republican, is considering the expansion of the state's Medicaid program, the Associated Press' Kim Chandler reports. Bentley, a dermatologist by training, remarked, "'I am concerned about the plight of the working poor ... If doctors are not paid for seeing those patients, doctors will not go to rural Alabama because you can't expect a doctor to go to rural Alabama and lose money."' The governor, however, said that funding the expansion would be a challenge.