Health Care In The States

Medicaid Expansion Already An Issue In Some Gubernatorial Races

By Phil Galewitz

July 5th, 2012, 10:32 AM

Hours after the Supreme Court upheld President Barack Obama’s health law but made its Medicaid expansion optional, Missouri Republican gubernatorial candidate Bill Randles said the state would be foolish to expand the health insurance program for the poor — even it means passing up hundreds of millions of federal dollars.

“States that accept this new Medicaid program will essentially be accepting total, government-run healthcare,” Randles, who is an attorney and an ordained minister, wrote on his campaign website.

There are 11 gubernatorial campaigns this year, including six like Missouri that have incumbents running for re-election. And experts say the health law – and specifically, whether states should opt into an expansion of Medicaid to cover more low-income people – is expected to come up in many of those. “Medicaid will be an issue anywhere Democrats have a chance to win,” said Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University. That includes states such as West Virginia, North Carolina, Washington state and possibly Missouri, he said.

The federal government is paying all of the costs for Medicaid expansion from 2014 to 2017; thereafter states have to pick up some of the added cost, but no more than 10 percent starting in 2020.

The other states with gubernatorial races are Delaware, North Dakota, Utah, Vermont, Indiana, Montana and New Hampshire.

Randles, who is vying for the Republican gubernatorial nomination in Missouri against businessman Dave Spence, said he believes Medicaid will be a “critical issue” in the election. Spence also opposes the expansion, which would cover more than 200,000 Missouri residents. The winner of the August primary will take on incumbent Gov. Jay Nixon, a Democrat, who has yet to take a position on the expansion.

Robert Blendon, professor of health policy and political analysis at Harvard, said that while Medicaid is a complicated topic, the candidates will debate whether their states should implement the law by creating new online insurance marketplaces and expanding coverage for the poor.

“Democratic candidates will say we should implement the law and put in exchanges and go after as much funding for coverage as possible, while Republican will say it’s too expensive,” he said.

That dynamic is already playing out in North Dakota, where Gov. Jack Dalrymple, a Republican, opposed the health law and reiterated that opposition after the high court’s ruling. “The health care plan is wrong for North Dakota,” he said last week. Dalrymple has not decided, however, whether to opt in to the Medicaid expansion, his spokesman said.

Ryan Taylor, his Democratic challenger, argues that expanding Medicaid “is an easy decision for North Dakota” for moral as well as financial reasons.

North Dakota is the one state where Republicans will have difficulty saying they can’t afford expanding Medicaid. In the midst of an oil and natural gas boom, the state is projecting a surplus of nearly $850 million for fiscal 2012.

Taylor, currently a state senator, said the Medicaid expansion would cover half the state’s 68,000 uninsured residents while increasing state spending on Medicaid by only 1.4 percent. Although Taylor said he expects the health law to be an issue in the campaign, he said it would take a back seat to how the state will manage its rapid growth.

3 Responses to “Medicaid Expansion Already An Issue In Some Gubernatorial Races”

  1. Sam Pilato says:

    First I want to thank you for making it so easy to communicate. This is my second time on the site to comment. Just wonderful. I’m still confused to why these governors are rejecting the “Affordable Care Act”, it would help there people, and after all isn’t that what it’s all about. Governors that reject this Act are only telling it’s citizens that they don’t give a hoot about them. Shame on them, no cost for 2 years, and then a meager 10%, why not try it to see if it is for your state? Of course we have to pay for these folks, which we already are straining our Emergeny rooms. I read your article about the Texas situation in Houston, what a mess, that example is enough to make everyone of these governors jump on board. We need to take care of our people, no it is not a right, however the prevelidge should be taken seriously so we can relieve the strain fron our emergeny room and the stress it puts on our doctors and nurses. These folks can’t give it all to each patients since the line is running out the door and creating an embarrasing environment for the hospital.

  2. Larry R. says:

    There are certain governors that are Tea Party governors. They were swept in with the Tea Party Tide of 2010 and most of them will probably be swept out with that same tide in 2014. However, while they are in office, they would not dare step outside of the policies that got them elected. They certainly would never break their Grover pledge. They promised to balance their budgets solely on the backs of teachers, police, fire fighters, sanitation workers, and any other public employee that they decide is unnecessary. Meanwhile, rather than seeing the promised tax rebate that these governors promised as candidates, the taxpayer has less of the critical public services they need so much. We see it all across America. Less spending on education, fire protection, police protection, trash and recycling schedules are cut in half, roads and bridges are less maintained. It’s true, it you have less government, you spend less money. Even a complete moron knows that! Gee, couldn’t we do that at home? Little Johnny is graduating high school next year. We are cutting our household education budget so Johnny can’t go to college and needs to find a job flippin’ burgers. That’s the mentality we have in at least 26 Tea Party states across America. Not smart government, not smart spending, not shared sacrifice, not fair and balanced cuts combined with fair and balanced tax revenues…just shut the wallet! That is what you call Neanderthal Government and that is what the Tea Party has introduced.

  3. economia says:

    I ultimatly know that the health insurance law is a sensible aspect of governance. It determine who got re-elected to vital position in the state.

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