Following Supreme Court Decision on ACA, Focus Shifts to Medicaid Expansion in States
July 16, 2015 09:20 AM
An adverse ruling by the US Supreme Court on the Affordable Care Act (ACA) subsidies could have sent Obamacare into a tailspin and resulted in chaos for the health care system nationwide. Instead, the Supreme Court upheld the legality of the ACA subsidies for individuals who purchase insurance through a non-state exchange, as previously reported.
With the Supreme Court having now twice upheld key components of the ACA, the common perception is that, while there may be some legislative changes to the law, Obamacare is likely a permanent fixture in our health care system. As a result, states that have not yet done so are facing renewed questions about adopting Medicaid expansion.
In announcing that Obamacare is “here to stay” following the Supreme Court ruling, President Barack Obama quickly pivoted to making the case for Medicaid expansion. “If we can get some governors that have been holding out and resisting expanding Medicaid primarily for political reasons to think about what they can do for their citizens who don’t have health insurance but could get it very easily if state governments acted, then we could see even more improvement over time,” Obama said at a press conference following the ruling.
The week after the ruling, President Obama furthered his case for Medicaid expansion by flying to Tennessee for a speech on the issue. In Tennessee, Governor Bill Haslam has supported Medicaid expansion but has been unable so far to convince the state legislature to approve it. “Understand that the way the law was set up, states have the option of expanding existing programs like Medicaid,” Obama said to a crowd in Tennessee. “Here in Tennessee, that's probably a couple hundred thousand people who could benefit. Given the strong history of innovation of healthcare in Tennessee, y'all should be able to find a solution. The federal government is here and ready to work with the states that want to get going.”
A previous Supreme Court decision in 2012 ruled that the ACA’s Medicaid expansion was unconstitutionally coercive and left it up to the states to opt out. So far, 30 states including the District of Columbia have adopted Medicaid expansion, while two states (Alaska and Utah) are considering adoption, and 19 states are not currently expanding Medicaid. The states that have not yet adopted Medicaid expansion are largely controlled by Republicans. According to the White House, these states could provide coverage to 4.3 million people currently without insurance by expanding Medicaid.
In addition to making the substantive case for Medicaid expansion, the Administration has demonstrated a willingness to work with states to accept specifically-tailored plans. This has allowed otherwise unwilling states to develop their own approaches. For example, the Republican-controlled Montana legislature approved a plan this year that required low-income individuals to pay premiums equal to 2 percent of their incomes and further required a third party contractor administer the program. Montana is currently preparing to work with the Centers for Medicare & Medicaid services to receive the necessary approval for the plan.
Other states like Alaska and Utah with resistant legislatures are continuing to work to achieve Medicaid expansion. In Alaska, where the state legislature voted down expansion proposals this year, Governor Bill Walker announced his intentions to proceed towards Medicaid expansion despite opposition from the legislature.
NAHC Reportwill continue to provide updates on Medicaid expansion efforts in the states.