What Will The States Do On Medicaid?

Many Republican state officials applauded the Supreme Court decision allowing states to opt out of the Medicaid expansion in the 2010 health care law, which was estimated to add coverage for 17 million people who are currently uninsured. Now the question looms: Will states that sued to strike down the health law forego the federal funding for the Medicaid expansion?

Public officials in several states have already expressed opposition to the expansion. Set to take effect in 2014, the Medicaid expansion would cover people who make up to 133 percent above the poverty line. The federal government will pay 100 percent of the cost for three years, gradually decreasing to 90 percent of the cost thereafter. States balking at the expansion say that 10 percent is too much for strapped budgets to absorb.

Here are the statements of public officials from various states.

Nebraska Gov. Dave Heineman (R):
“If this unfunded Medicaid expansion is implemented, state aid to education and funding for the University of Nebraska will be cut or taxes will be increased. If some state senators want to increase taxes or cut education funding, I will oppose them.”

Mississippi Gov. Phil Bryant (R):
“Before I will make deep draconian cuts in education and in transportation and workforce development, we will certainly seek opportunities that the state will have to reduce the welfare cost to Mississippians. If you look at adding 400,000 [people] that certainly will damage this budget beyond repair.”

Mississippi Lt. Gov. Tate Reeves (R):
“An expanded Medicaid program would add almost 400,000 new enrollees and cost the state an estimated $1.7 billion over the next 10 years. Mississippi taxpayers simply cannot afford that cost, so our state is not inclined to drastically expand Medicaid. True health care reform should look at reducing costs for services not increasing the burden on taxpayers.”

An expanded Medicaid program would add almost 400,000 new enrollees and cost the state an estimated $1.7 billion over the next 10 years. Mississippi taxpayers simply cannot afford that cost, so our state is not inclined to drastically expand Medicaid. True health care reform should look at reducing costs for services not increasing the burden on taxpayers.”

Missouri House Budget Chairman Ryan Silvey (R):
Asked in an interview with KHN whether the state would accept the federal funds, Silvey said: “I don’t see any chance of that happening.” He said the state can’t afford to pay more than $100 million a year starting in 2017 to pay its portion of the coverage expansion. “It’s just not a sustainable option.”

He said the Medicaid expansion would result in cuts in state spending on education and public safety. “My job is to balance the state budget,” he said when asked how turning down the expansion money would play.

Missouri Gov. Jay Nixon (D):
The Democratic governor of Missouri, however, is still studying the decision. From Gov. Nixon’s statement: “We’re just now beginning to review this ruling so that we can understand exactly what it means for Missouri. This ruling has significant complexities and implications for families, health care providers and insurers in our state.  Here in Missouri, I’m committed to working collaboratively with citizens, businesses, medical providers and the legislature to move forward in a way that works best for families in our state.”

Idaho state Rep. Maxine Bell (R), chairwoman of the House Appropriations Committee:
“I assume we can’t pursue it [the expansion] because we can barely afford what we’re doing now. I can’t imagine where we’ll find the revenue.”

Early word from officials in most other states was that they needed to study the ruling more to understand the implications of the decision.

Texas Democratic state Rep. Garnet Coleman:
The governor and others “will do everything they can to stop the expansion under the law, but they’ll have to answer to the public.” He called the Medicaid expansion “a bargain” and a job creator with new hospital jobs, nurse jobs, etc. “I’ll want to wait and see how [U.S. Health and Human Services Secretary Kathleen Sebelius] interprets the ruling and what kinds of carrots could be used for the expansion.”

Rey Torres, communications director for Arizona House Republicans:
It is “too early to discuss” whether Arizona will pursue a Medicaid expansion. “There’s certainly no appetite to expand the government. … We’ll wait until after the election” to discuss it further.

Mike Philipsen, spokesman for the Arizona Senate Republicans:
“It has a huge impact on our state – hundreds of millions of dollars. … Where does this money come from? We don’t know right now. That’s something that we will be discussing.”

Sherriene Jones-Sontag, spokeswoman for Kansas Gov. Sam Brownback (R):
“While the court did rule that the federal government cannot withdraw all funding from states who refuse to expand Medicaid, every other onerous provision stays, including the ‘maintenance-of-effort’ requirements that severely limit governors’ ability to manage Medicaid to the best needs of their states. The Brownback Administration continues to oppose ObamaCare and will not take any action to implement ObamaCare. This is now a political issue that will be resolved by the American people in the November elections.”

Indiana Gov. Mitch Daniels (R):
“The court’s ruling … must be respected. But many actions that are constitutional are still unwise.”

Texas Health and Human Services Executive Commissioner Tom Suehs:
“I’m pleased that it gives states more ability to push back against a forced expansion of Medicaid. The court clearly recognized that the Affordable Care Act put states in the no-win situation of losing all their Medicaid funding or expanding their programs knowing that they would face billions of dollars in extra costs down the road. I remain concerned that expanding Medicaid without reforming it only multiplies the tremendous budget pressure the program puts on states.”

South Carolina Gov. Nikki Haley (R):
“The best thing Washington can do for us is allow block granting [of Medicaid}. Let us have the block grants in a way that we need. Let us spend the money in the way that we need. We know best what the people of South Carolina need.”

Colorado Attorney General John W. Suthers (R):
“The court held that the federal government cannot hold the entirety of a state’s federal Medicaid funding hostage if the state chooses not to expand its Medicaid program. This means, at least, that there are limits on the federal government’s power to compel states to make policy.”

Jeffrey Hess, Jim Burress, Phil Galewitz, Shefali Kulkarni, Sarah Barr, Christian Torres, Matthew Fleming and David Schwartz contributed to this report.