Joy Wilson, health policy director for the National Conference of State Legislatures, said the 2013 legislative session likely laid the groundwork for reluctant legislatures to pass the expansion next year—when states will have lost only one year of the three-year 100% federal funding for expansion.
“I think some states will reconsider next year,” Wilson said.
For instance, the Missouri legislature—which rejected Democratic Gov. Jay Nixon's repeated efforts to pass a Medicaid expansion—plans to convene a committee to study the issue before the 2014 session.
Meanwhile, advocates for expansion in some states, including Iowa and Ohio, also have voiced some support for voter referendums. The ballot push is based on the belief that voters are more supportive of the expansion than Republican legislators, who have generally opposed adding millions of new beneficiaries to a program they view as costly and a poor insurer.
The ballot push may get a boost in some conservative states from recent polling that found broad support for Medicaid expansion. Sixty-two percent of voters in Alabama, Georgia, Louisiana, Mississippi and South Carolina supported the Medicaid expansion, according to polling released Tuesday by liberal Families USA. That support came despite a pluralities' opposition to the overall law, which generally mirrored national polls.
But advocates of expansion do not all support taking the issue to the voters.
Peter Wertheim, a spokesman for the Arizona Hospital and Healthcare Association, said the state's hospitals oppose a ballot initiative over the legislature deciding on it. The state Senate passed a Medicaid expansion, but it ran into opposition in the House, where Speaker Andy Tobin has urged it be sent to the voters.
“We elect our legislators to get this job done,” Wertheim said.
The referendum route would push back a decision on the bill until the fall, reducing needed implementation time and adding the costs of a potentially pricey campaign, he said.
Instead, hospitals and their allies in the state—under the umbrella group Restoring Arizona—are using rallies, and advertising to push reluctant House Republicans to approve the expansion.
Iowa lawmakers deadlocked
Iowa legislators remain deadlocked over a Medicaid expansion, as its legislation session nears its end, according to the Associated Press.
Lawmakers have not found a compromise on whether to expand Medicaid or to pass an alternate healthcare plan offered by Republican Gov. Terry Branstad. Some legislators have discussed the possibility of concluding the session without finishing the debate and to return later on that issue in a special session.
Democrats, who control the Senate, have advocated on behalf of Medicaid expansion, while Republicans running the House prefer Branstad's plan to revamp an existing program for low income Iowans.