Medicaid expansion

Attempts by legislative leaders to use Alaska's budget to stop the governor from accepting federal funds to expand Medicaid are likely unconstitutional, the Alaska Dispatch's Pat Forgey reports.

The governor wants to expand healthcare coverage to 20,000 or more low-income Alaskans. Legislators included provisions in the operating budget aiming to stop Governor Bill Walker from unilaterally accepting $130 million in federal money for the program.

Counsel for both the governor and for the legislature have concluded the legislative language is likely unconstitutional because the state constitution confines budget bills to appropriations.

As many as 45,000 more Montanans will be get health coverage after legislators have passed a bill to expand Medicaid, The Huffington Post's Jeffrey Young reports. Gov. Steve Bullock, a Democrat, supports expanding Medicaid. The expansion also must be approved by the federal government because it includes new requirements for enrollees, including monthly premiums.

Two years ago, the expansion failed because a supporter cast the deciding vote the wrong way accidentally, Young reports.

A duel is being set up between the Utah Senate and the Utah House on how much to expand Medicaid, The Salt Lake Tribune's Kristen Moulton reports. A House committee voted down a plan backed by the governor and passed by the Senate. Instead, the House Business and Labor Committee passed a plan sponsored by the House majority leader that would cover 46,500 more people.

Arkansas and Kentucky, followed by Oregon, Washington and West Virginia, had the sharpest reductions in their uninsured rates among adult residents, Gallup reports. Of the 11 states that had the greatest increases in the number of their residents who have health insurance, 10 expanded Medicaid.

Massachusetts has the lowest uninsured rate in the country at 4.6 percent, and Texas has the highest at 24.4 percent.

Republican-sponsored bills to expand Medicaid in Wyoming died last week, the Casper Star Tribune's Trevor Graff and Laura Hancock report. The proposal would have expanded healthcare to 17,600 uninsured Wyomites, they report. One bill died in a Senate committee, and a similar bill was pulled from the House. Eric Boley, president of the Wyoming Hospital Association, "hospitals around the state are stuck with hundreds of millions of dollars in uncompensated costs annually as uninsured people are treated at emergency rooms." Proponents, however, plan to try again in the future.

The stars were aligned for Tennessee Gov. Bill Haslam to expand Medicaid in his state to 280,000 low-income Tennesseans: "Hospitals and chambers of commerce endorsed the plan. A recent poll showed Haslam had an 86 percent approval rating among Republicans in the state, and he has a GOP supermajority in the House and Senate." But the plan died this week after a state Senate committee voted the plan down, The Tennessean's Dave Boucher reports. Haslam said that he didn't realize how deeply Republican legislators had issues with the federal government: '"I think this whole sense of distrust of the federal government. Well, I could've told you that was, that our legislature felt that way (before the special session). It was so much bigger than I thought.'"

After the Republican governor of Indiana reached an agreement to expand Medicaid under Obamacare by imposing new costs on poor adults, promoting healthy behaviors and relying on financing from smokers and hospitals, other Republican-led states might be more interested in signing up more Medicaid enrollees, Kaiser Health News's Phil Galewitz reports. Indiana is the 28th state to expand Medicaid.

The Obama administration granted Governor Mike Pence's administration a three-year waiver from the federal government to make Medicaid more like private insurance by including cost-sharing for receipients below the poverty level.

While advocates favor the expansion, there is criticism for the part of the plan that would lock people out of their Medicaid coverage for six months if they don't pay their premiums, Galewitz reports.

The Republican governor of North Carolina, Pat McCrory, has expressed interest in expanding Medicaid in that state, the Associated Press reports. While North Carolina was one of 24 Republican-helmed states that initially resisted expanding healthcare coverage for the poor under President Barack Obama's signature law, "McCrory said he is open to expanding Medicaid coverage after he and the General Assembly revamp the program to control costs," according to the AP. Medicaid expansion in North Carolina would benefit 320,000 low-income workers.

Legislators in Montana have proposed a limited expansion of Medicaid that would cover 15,000 to 18,000 people earning less than 100 percent of the federal poverty level, the Independent Record reports, but the plan would not allow Montana to take a federal subsidy that would expand coverage to 70,000 more people. Democratic Governor Steve Bullock wants to accept the money. The federal government would pay the entire cost in 2016 and 95 percent of the cost in 2017,  but the state would have to pick up 10 percent of the expansion cost by 2020, the newspaper further reports.

Legislators in Utah have rejected Governor Gary Herbert's alternative plan to providing Medicaid expansion to low-income Utah residents in favor of two even more limited proposals, The Salt Lake Tribune's Kristen Moulton reports. The Legislature’s Health Reform Task Force "proposed recommending options that would cover between 12.5 percent and 20 percent of those below the federal poverty line — but only those who are mentally ill, addicted, disabled or too sick to work," Moulton reports. The governor's plan would cover 46,000 people.

David Patton, executive director of the Utah Department of Health, told Moulton he is still hopeful that the full Legislature will pass Medicaid expansion.