Reform Update: Medicaid expansion could occur in red states in coming weeks

The coming weeks are shaping up to be a big deal for states still on the fence regarding Medicaid expansion.

Democrats in Pennsylvania are trying to force a vote in that state's Legislature, Philadelphia's CBS affiliate reported today. Democrats in the Keystone State recently failed in an effort to get a Medicaid expansion included in a budget bill that could be voted on today. In addition, Republican Gov. Tom Corbett is said to be in negotiations with the Obama administration on how the state might satisfy the Medicaid provisions of the Patient Protection and Affordable Care Act.

The healthcare reform law calls for states to raise the threshold for coverage to at least 133% of the federal poverty level. Even in states where Republican governors have gotten on board in order to qualify for new federal funding, passing the legislation to make it happen has proved difficult.

In Michigan, where Republican Gov. Rick Snyder has been coaxing lawmakers in his party to reach a deal, a revised Republican-sponsored bill could move out of a House committee as early as today the Associated Press reported. A previous version would have capped benefits at four years for the newly covered residents. The modified bill would instead allow them to get subsidized coverage on the state's health insurance exchange or pay more to continue Medicaid coverage.

Arizona Republican Gov. Jan Brewer was dealt a blow Monday after her Medicaid plan failed to make it out of a House committee, the Arizona Republic reported today. However, a bipartisan coalition of lawmakers could attach the expansion to another bill during floor debate today. If Arizona expands Medicaid, it would add 350,000 Arizonans to the program's rolls, according to state estimates.

What's in a name, you might ask. Well, if you're Iowa Gov. Terry Branstad, it helps determine whether the Hawkeye State will expand Medicaid. Iowa Public Radio recently reported that the Republican governor, who in the past vehemently opposed a Medicaid expansion, changed his mind by instituting Medicaid his way and with a new name, the Iowa Health and Wellness Plan. The program would expand eligibility for Medicaid up to 138% of the federal poverty level, but differs from expansion in other states in that it integrates accountable care organizations into the program at the outset. The plan would also collect premiums from enrollees making at least 50% of the federal poverty level, although the premiums would be waived for participation in wellness activities.

Health officials from two states are traveling to Washington this week to share a message on Medicaid reform: Let us handle it. Scheduled witnesses for a Wednesday hearing before the House Energy and Commerce Health Subcommittee include Tony Keck, director of the South Carolina Department of Health and Human Services, and Arkansas Surgeon General Dr. Joe Thompson. The Republican governors in those states have flatly declined to expand Medicaid under the Affordable Care Act. Both officials, according to prepared testimony, will describe homegrown plans to reinvent their programs.

Follow Jonathan Block on Twitter: @MHjblock