NCPA - National Center for Policy Analysis

Medicaid Expansion: Beyond Yes or No

April 4, 2014

Governors across the country are negotiating with the Centers for Medicare and Medicaid Services (CMS) to implement solutions for their Medicaid programs that focus on the needs of their state, rejecting the static, blindly restrictive choice to simply expand or not under the Affordable Care Act (ACA). The administration should be welcoming innovative solutions at the state level, not delaying approval or restricting programs from Washington, says Angela Boothe, a health care policy analyst at the American Action Forum.

States (even those not expanding their programs) are facing increasing Medicaid applications and enrollment numbers, signaling new costs and heavy impacts on state budgets. Governors are tasked with the challenge of providing care for those who need it most while managing these growing costs.

  • Wisconsin Governor Scott Walker recently launched a new Medicaid-reform initiative that deems all individuals earning up to 100 percent of the federal poverty level (FPL) (and children up to 300 percent FPL) eligible for Medicaid services and moves those above 100 percent of the FPL to the Federally Facilitated Marketplace to receive subsidized coverage.
  • With this change, Wisconsin will still provide Medicaid coverage to its poorest and most vulnerable residents, while greatly decreasing the number of individuals on waiting lists for Medicaid services.
  • By moving more individuals into the insurance marketplace, Governor Walker's reforms will also place more responsibility for health coverage in the hands of the individuals receiving care.
  • Between Medicaid and the exchange, an estimated 224,580 people will receive coverage -- reducing the size of Wisconsin's uninsured population by 47 percent.

Governor Walker is not alone in working to improve Medicaid at the state level.

  • Under Governor Mike Beebe, Arkansas is pursuing Medicaid expansion using a market-based approach for its uninsured population of over 500,000.
  • Governor Tom Corbett of Pennsylvania, meanwhile, has a plan that encourages individuals to move into the workforce.
  • Other states have implemented personal-responsibility provisions in their Medicaid programs as well, including Indiana and Oklahoma. Yet these programs will be phased out due to the restrictions imposed by ObamaCare.

There is no silver bullet for bending the Medicaid cost curve and these are ideas we should be exploring. Governors are ready to innovate, but they need a willing partner in CMS.

Source: Angela Boothe, "Medicaid Expansion: Beyond Yes or No," Real Clear Policy, April 1, 2014.


Browse more articles on Health Issues