API: Alabamians should not be fooled by 'backdoor approach to Medicaid expansion'

BIRMINGHAM, Ala. — Katherine Robertson, vice president of the staunchly conservative Alabama Policy Institute, warned Alabamians on Wednesday that they should not be “fooled” by a potential “backdoor approach to Medicaid expansion as introduced in” ObamaCare.

In several states around the country, Republican governors have recently proposed plans that eerily resembled Medicaid expansion under ObamaCare, but have used new “nomenclature,” or terminology, to cloak the plans in conservative-sounding rhetoric.

“This week, Tennessee Governor Bill Haslam announced his proposal for a ‘Medicaid expansion alternative’ that would expand the program to nearly 200,000 currently ineligible individuals in the state,” Robertson explained by way of example. “Also called a ‘hybrid plan,’ Haslam’s version of expansion would provide Medicaid-funded vouchers to be used for premiums and other expenses for employed individuals making less than 138% of the federal poverty level,” the same level set by ObamaCare’s expansion requirements.

Robertson also said that the Republican governors of Arkansas and Pennsylvania have essentially expanded Medicaid, “while simultaneously characterizing ObamaCare expansion as a bad idea.”

She explains what happened in both states:

Arkansas Governor Beebe received approval to expand Medicaid through waivers allowing Medicaid dollars to go toward the purchase of private insurance for those falling below 133% of the federal poverty line. In the agreement, the federal government imposed a per-person cap on the cost whereby anything beyond a certain amount would be paid for by the state (taxpayers). Shortly after implementation, the plan’s cost went well over the limit and the state was left asking for a raise in the caps due to difficulties encountered in predicting the cost. A September 2014 report by the Government Accountability Office found that Arkansas’s cost assumptions were so far off that the plan would cost the federal government nearly $800 million more than traditional expansion. Even though Arkansas’s private option expansion has proven to be a failure, it is still being hailed as a worthy blueprint by some Republican governors seeking a way out of their commitments to reject new federal money for Medicaid.

In Pennsylvania, Governor Tom Corbett also pushed his “Healthy PA Plan” as an “alternative” to Medicaid expansion under the ACA. The plan is expected to expand Medicaid to over 500,000 uninsured individuals, but it is considered an alternative because, much like Arkansas’s plan, federal Medicaid money would be used to provide private health insurance to beneficiaries. The plan “created in Pennsylvania, for Pennsylvania” was supposed to contain tougher premium requirements, but the approved plan contained even less stringent requirements than those already in place. Corbett also touted his plan’s job search requirements for enrollees which never made it into the final waiver approved by the federal government.

The Arkansas and Pennsylvania plans both bear similarities to some of the Medicaid expansion proposals Alabama Gov. Robert Bentley is weighing.

Similar to the Arkansas plan — which has seen its costs to state taxpayers even surpass traditional Medicaid expansion — Bentley has said he’d like to be able to funnel federal tax dollars through the state government and into private insurers, who would cover the uninsured individuals.

Similar to Pennsylvania’s unsuccessful pitch to the Obama Administration, Bentley has mentioned some form of work or workforce training requirement for new individuals receiving insurance.

“Republican Governors and legislators who have repeatedly laid out principled cases against Medicaid expansion should not be permitted to repackage expansion under new nomenclature,” Robertson concluded. “We should not be fooled. These state-sponsored alternatives are merely a backdoor approach to Medicaid expansion as introduced in the Affordable Care Act. Such plans are costly, unsustainable, inflexible, and most of all, not free.”