The Obama administration sought to recruit city leaders Monday in the ongoing battle to expand Medicaid nationwide.
HHS Secretary Kathleen Sebelius urged attendees at the National League of Cities' annual legislative forum to join in the administration's ongoing push to convince Republican governors to expand their Medicaid programs, as called for by the Patient Protection and Affordable Care Act.
“As CEOs of cities, we hope the question of whether the costs outweigh the benefits will be a conversation that you will be actively involved in,” Sebelius said.
Sebelius characterized governors who are refusing the expansion as “playing politics” because they were opposed to the underlying 2010 federal healthcare overhaul. That law envisioned using a national Medicaid expansion to provide coverage to about half of the 30 million people who were expected to gain insurance under its provisions.
Some governors—mostly Republicans—have said they fear their states will be on the hook for the new coverage if the federal government reneges on its promise to pay the bulk of the costs. Some also have said they view Medicaid as a broken program and disagree with expanding its scope until it's fixed.
About 24 governors have committed to expanding the program, at least temporarily, but some of them face challenges in convincing leery legislators to go along. For example, a Florida Senate committee appeared to derail Gov. Rick Scott's agreement with Sebelius to expand Medicaid to about 1 million state residents when it voted Monday to instead move toward a managed-care system.
Regardless of whether every state goes along with the Affordable Care Act's Medicaid provisions, Sebelius said she was going to need the help of local officials in ensuring the public discovers new insurance coverage expected to begin in 2014. Every state will offer subsidized insurance through health insurance exchanges, which will begin enrolling beneficiaries for the first time in October.
“As we get closer to Oct. 1—I'd say from Labor Day on—we will be actively trying to engage you and engage your outreach networks,” she said.
Sebelius also urged the local officials to raise concerns about the impact of the budget sequester on programs in their areas. The $1.2 trillion in cuts in federal spending over the next 10 years began March 1 and include many healthcare initiatives of local governments, including mental health services.
“People need to know what's happening on the ground and in your cities isn't a game; it's a real threat to local economies and it's endangering the well-being of millions of Americans,” she said.