More GOP Governors Back Medicaid Expansion Alternatives

A small but growing number of Republican governors and GOP-led legislatures are seeking federal approval and funding to implement alternative Medicaid expansion plans while continuing to oppose the Affordable Care Act, the Washington Post reports.

According to the Post, the strategy allows the governors to remain distant from the ACA and ensure that their states do not miss out on additional federal funding.

For example, Indiana Gov. Mike Pence (R) -- a former U.S. House member who was a vocal opponent of the law -- has sought a waiver to use federal Medicaid expansion funds to expand the Healthy Indiana Plan, which provides about 45,000 low-income residents with personal health funds linked to high-deductible coverage plans.

On Friday, Pence met with HHS Secretary Kathleen Sebelius to discuss his plan. He said later, "I've made it very clear that I have no interest in expanding traditional Medicaid in Indiana," adding, "Medicaid is a deeply flawed system ... it's broke, and broken, and it ill serves the people that are covered."

Similarly, Pennsylvania Gov. Tom Corbett (R), Utah Gov. Gary Herbert (R), and Wisconsin Gov. Scott Walker (R) have passed or announced plans to enact alternative Medicaid expansions.

Diane Rowland, executive vice president at the Kaiser Family Foundation, said the GOP governors are "trying to put some distance between the straight concept of a Medicaid expansion so they can build a coalition in the legislature," adding, "A waiver makes it sound like they've negotiated something different and gotten a better deal."

Meanwhile, two Democratic governors -- Arkansas' Mike Beebe and New Hampshire's Maggie Hassan -- have worked with their states' GOP-controlled legislatures to advance "private option" Medicaid expansion plans (Wilson, Washington Post, 2/24).

GOP Governors Who Embraced Medicaid Expansion Better Positioned for 2014

Despite threats of retaliation from opponents of the ACA, GOP governors who have embraced Medicaid expansion appear to have a better chance of re-election than those who did not, according to political observers, Politico reports.

Republican governors supporting expansion -- including Iowa Gov. Terry Branstad, Michigan Gov. Rick Snyder, New Mexico Gov. Susana Martinez, Ohio Gov. John Kasich and Tennessee Gov. Bill Haslam -- are considered to be front-runners in their respective gubernatorial races this year. In Nevada, Gov. Brian Sandoval (R) -- who is the only GOP governor to embrace Medicaid expansion, as well as support the creation of a state-run insurance exchange -- is not facing a significant challenge from either Democrats or his own party.

Although longtime ACA opponents in those states have expressed frustration with their governors, they no longer are threatening to remove them from office, according to Politico. Using former President Regan's quote -- "An 80% ally isn't a 20% traitor" -- Americans for Prosperity President Tim Phillips noted, "It means we don't write them off when they've done a lot of good things."

Conversely, governors who consistently have opposed or blocked Medicaid expansion "have found themselves skewered by the left," according to Politico. Democratic Governors Association Chair and Vermont Gov. Peter Shumlin said those governors are "turning those federal dollars down because they don't like the president or to make a political point," adding, "Those folks are going to be punished at the polls" (Cheney/Hohmann, Politico, 2/25).

Democratic Governors Ask White House To Boost ACA Promotion

Democratic governors who have been promoting and implementing the ACA at the state level without much help from the White House are now turning to the Obama administration for help ahead of the 2014 elections, Politico reports.

For example, Massachusetts Gov. Deval Patrick (D) said the current federal promotion efforts bear little resemblance to those used to gain support for the state's 2006 health system overhaul. "It's not a critique; it's an observation that not only did we sell [the state law], but we had allies in selling it," Patrick said.

Similarly, Missouri Gov. Jay Nixon (D) and Delaware Gov. Jack Markell (D) have both suggested that the White House could do more to highlight positive effects of the law, such as state-level health care innovations and efforts to control health care costs (Burns et al., Politico, 2/25).