Hospitals are geared up for a state-by-state battle for the Medicaid coverage promised by the healthcare reform law, and to get Congress to compensate them if the promise is broken.
The U.S. Supreme Court's landmark decision upholding much of the Patient Protection and Affordable Care Act also struck down the law's financial penalty for states that do not expand their Medicaid program to all individuals with incomes up to 138% of the federal poverty level. That decision turned attention to the governors of the 26 states that sued to overturn the law and where many provider and patient advocates have begun assembling a push for Medicaid expansion.
Republican officials in several of those states are digging in their heels.
“But even though the federal government has promised to initially pay 100% of the increase in Medicaid payments for the first three years of Obamacare, the burden increasingly shifts to Florida taxpayers in future years,” Florida Gov. Rick Scott said in a statement. Under the law, the federal government provides 100% funding for the newly eligible Medicaid beneficiaries in 2014 through 2016 and then the federal share tapers down to 90% by 2020 and thereafter.
Scott was one of 15 Republican governors to issue a statement in the immediate aftermath of the healthcare ruling voicing continued opposition to implementing the law. He was the first of five of the nation's 29 Republican governors—in Florida, Louisiana, South Carolina, Iowa and Mississippi—who by Independence Day specifically said they would refuse the Medicaid expansion.
The toughening resistance to a central pillar of the healthcare overhaul—the Medicaid expansion was expected to provide coverage to at least half of the 32 million people expected to gain coverage under the law—heralds a grueling state-by-state fight over expanding the program.
Amid these fissures in the near-universal coverage envisioned under the law, some hospitals are feeling jitters about the impact of an influx of patients newly covered by Medicaid and where state and federal officials will find the money to pay for it.
Dr. Sheldon Retchin, CEO of Virginia Commonwealth University Health System, Richmond, said that although he personally supports the expansion, it could exacerbate emergency department crowding because of the inability of office-based physicians to treat more Medicaid enrollees.