The CMS still would have to approve major Medicaid changes contained in the legislation, including substantial cost-sharing by beneficiaries, which is uncertain.
“We knew it was going to be a long race, but it was more than we envisioned,” Grant said.
Under the Patient Protection and Affordable Care Act, the federal government will pay 100% of the cost for the expansion population for the first three years, and 90% after that. It's a key element of the law's coverage expansion. If all 50 states approve the expansion, it's projected that would reduce the uninsured population by
10.2 million by 2022 and provide hospitals with an additional $294 billion from 2013 to 2022, helping them provide care for the uninsured. So far, only 25 states have OK'd expansion.
The spotlight now shifts to Indiana, Ohio, New Hampshire, Pennsylvania and Tennessee, where debate continues over whether to expand for 2014. Virginia is even more iffy. New Hampshire and Virginia established commissions to study the issue. In all those states, Republican lawmakers and/or Republican governors have opposed the Medicaid expansion and the ACA, arguing that expanding Medicaid will end up imposing a heavy cost on their states. Hospitals are among the groups leading the fight to expand coverage. There is no deadline for states to adopt the expansion.
“The way we categorize states is moving forward at this time, not moving at this time and debate ongoing,” said Robin Rudowitz, associate director at the Kaiser Commission on Medicaid and the Uninsured. “So we had moved Virginia to 'not moving forward' because they passed a bill for this commission to explore, and there was really no indication that they were moving forward for January 2014.”
Jesse Cross-Call, a policy associate at the left-leaning Center for Budget and Policy Priorities, which favors Medicaid expansion, is watching New Hampshire, which also established a commission to make reform recommendations about its Medicaid program and recommend whether to expand. Cross-Call said New Hampshire has a hard deadline of October for its commission recommendations, and he lists the state as “leaning toward expansion.”
Medicaid expansion will be a big issue for the GOP-controlled Pennsylvania Legislature when it returns in the fall. Republican Gov. Tom Corbett has opposed Medicaid expansion.
In Michigan, Grant explained that the political dialogue evolved from one about expanding a government program to a discussion about how to restructure the program to lower costs and improve care. It also helped that Snyder pushed hard for expansion.