With the future of Medicaid expansion hinging on several state contests for governor, Health and Human Services Secretary Sylvia Mathews Burwell offered an election-day deal for Tuesday’s winners.
Burwell issued a call to the governors of the 22 states that have opposed Medicaid expansion, suggesting she is willing to compromise on the terms of the program.
“My message to governors is that if you’re interested in expanding, call me,” Burwell said in an address to the National Association of Medicaid Directors in Washington D.C. “And to those governors who are about to get elected or re-elected today my message is that I’m happy to meet with you before your inauguration. We welcome conversations as we work together to move forward.”
So far, 27 states and the District of Columbia have agreed to expand Medicaid as part of the Affordable Care Act. Medicaid expansion under the healthcare law provides health insurance for adults under 65 who earn up to 133 percent of the poverty level (currently $11,670 for a single adult).
But nearly two dozen states have resisted expansion, in part because the federal government reduces reimbursement for the extra cost by up to ten percent after the first three years.
Many governors are fearful of the financial burden on states already coping with lower tax revenue and increasing debts.
Burwell touted alternative types of Medicaid expansion in states including Michigan, Arkansas, Iowa and Pennsylvania, the latter of which expanded coverage in September under a program called “Healthy Pennsylvania.”
Burwell said other states who have resisted expansion could work out a similar deal.
“We worked with Pennsylvania and we want to work with other states, who are also interested in expanding, to help meet the needs of their residents,” Burwell said. “We’ve already worked with 27 states and D.C. to make this happen, and we want to work with you.”
Medicaid expansion plans for the remaining 22 states could shift after today, depending on the outcome of several gubernatorial races.
In Maine, Florida, Kansas and Georgia, the contests for governor are close, and if Democrats win, lawmakers are likely to move quickly to expand Medicaid in those states.
Burwell argued the expansion has lowered Medicaid costs and increased access to care for thousands of poor adults.
According to the non-partisan Congressional Budget Office, the additional costs to states who expand Medicaid represents a 2.8 percent increase over what they would have spent without joining the program, though the number could be less because overall health costs are expected to decrease.
Critics of Medicaid expansion argue the program is already overburdened and that women and children enrolled under traditional Medicaid will have a more difficult time accessing quality care. The same critics say the Republican alternative to expanding Medicaid, including the program in Pennsylvania, essentially mirrors the expansion under the healthcare law that has taken place in other states.
